For Clinicians | What Diseases Spread After a Hurricane, Flood or Fire

Ranked by the Surveillance Data

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase

Natural disasters that displace a lot of people (hurricane, flood or wildfire) can lead to sickness. I don’t know about you, but I always pictured something specific to the natural disaster; for example in a hurricane it would be something waterborne and making those in contact with the floodwater itself sick.

What truly makes people sick after a storm has less to do with the disaster itself than with what happens next: a few hundred people evacuated into one building, sharing air and bathrooms for a week. The disaster displaces people. The crowding is what spreads the post-disaster disease. Crowding is something we as clinicians can help our patients be ready for ahead of time.

Today we’re busting some myths: what really spreads after a natural disaster, and in what order.

Can you get sick at a hurricane or wildfire evacuation shelter?

Yes, and it’s the most likely way you get sick after a disaster.

The two best data sets we have on this are both wildfire shelters. In January 2025, the Pasadena Convention Center opened as an evacuation shelter for the Eaton fire and held about 1,700 people by the second night. Over six weeks of operations, enhanced surveillance counted 104 cases of norovirus, 56 of COVID-19, 29 of influenza, and 30 of nonspecified respiratory illness.¹ Every category on that list is viral. Nine of the norovirus patients and six of the COVID-19 patients were hospitalized.¹

In November 2018, norovirus moved through eight of the nine Camp Fire evacuation shelters in Butte and Glenn counties: 292 cases among roughly 1,100 evacuees, an estimated 27% attack rate, median patient age 63.² Twenty-one of them, 7%, needed evaluation at a hospital or urgent care.²

Not a drop of floodwater in either one. What those two events shared was several hundred people in one building sharing bathrooms and air for weeks, which is exactly what a hurricane evacuation also produces.

Pasadena had written its shelter infection control protocols partly off the 2018 Camp Fire outbreak, and a site visit on day six still found no adequate isolation area, inadequate hand hygiene and PPE use, and cleaning products that don’t kill norovirus.¹ 

What the two responses came down to:

• Screening arriving evacuees for GI symptoms at registration, which is where Camp Fire caught cases²
• A real isolation area for people who were sick, with their own toileting and handwashing
• Handwashing with soap and water rather than hand sanitizer, because alcohol does little to norovirus²
• Around-the-clock cleaning with a disinfectant that works on norovirus, meaning an EPA List G product¹

There is no medication anywhere in either response. At Eaton, COVID-19 and influenza antivirals weren’t even available on site.¹ Both reports are observational, so infection control is temporally associated with cases falling rather than proven to have caused it.¹ 

Reports fell sharply nine days after the first site visit.

What infections actually go up after a flood?

The waterborne part of the story isn’t wrong, it’s just smaller than it looks, and it’s a different list than most people picture. This tier belongs to water. Wildfire evacuation carries the shelter risk above, not this one.

Lynch and Shaman ran 23 years of national surveillance data against tropical cyclone exposure in the United States, 1996 through 2018, and tested six waterborne diseases. Three went up:

1. Cryptosporidiosis, up 52% during storm weeks³
2. Shiga toxin-producing E. coli, up 48% the week after a storm³
3. Legionnaires’ disease, up 42% two weeks after a storm³

The other three didn’t. Salmonellosis and giardiasis weren’t greatly associated with storm exposure, and shigellosis rates dipped slightly.³

The two GI infections on that list are managed with fluids and rest, not antibiotics. With STEC that isn’t a preference: the IDSA guideline says to avoid antibiotics when Shiga toxin is involved, because of the risk of hemolytic uremic syndrome.⁴ Legionnaires’ does need an antibiotic, but it’s pneumonia, so it needs a diagnosis and usually a hospital first. It also isn’t coming from the floodwater. It comes from the building’s own plumbing after the power goes out and the water sits warm and still.

Quick reference: what actually spreads, and what stops it

WHO laid out the pattern in 2007: outbreak risk after a disaster tracks population displacement, water and sanitation, crowding, the baseline health of the population, and access to care, rather than the disaster itself.⁵ The tiers below run roughly in the order the surveillance data supports, though no single source ranks them head to head.

Tier 1: viral illness in shelters. Norovirus, COVID-19, influenza, and the respiratory illness that never gets a name. It moves person to person in crowded congregate housing, and what holds it down is the infection control above.

Where a prescription fits: no antiviral touches norovirus, and for influenza and COVID-19 the gate is the clock and the prescriber, not the test.⁹ That gap is what preparation closes. Oseltamivir and nirmatrelvir-ritonavir are both JaseCase add-ons, and ondansetron is in the base kit for the vomiting norovirus causes. All of it is reviewed and prescribed by a licensed provider ahead of time, for emergency use only after trying to reach care.

Tier 2: skin and soft tissue infection. Cuts and punctures during cleanup, contaminated by debris and standing water. Gloves and boots prevent most of it, irrigating early with clean water prevents more, and tetanus vaccination should already be current before anyone starts hauling drywall.⁶

Where a prescription fits: here, and only here. A wound that has become infected with spreading cellulitis, in a patient who can’t reach care, for emergency use only after trying. Not an abscess, which needs drainage rather than a pill.

Tier 3: the water-ecology infections. Leptospirosis comes from skin or wound contact with fresh water carrying animal urine. Vibrio vulnificus comes from an open wound meeting warm brackish or coastal water.

Where a prescription fits: not at home. Vibrio needs IV antibiotics and usually an operating room.⁸ Leptospirosis does have an oral answer in doxycycline, but the symptoms are indistinguishable from flu and dengue without testing, and 10% of the post-Fiona cases were dengue-positive too.⁷

Tier 4: the rare ones.Mucormycosis is a fungal wound infection, melioidosis a soil bacterium. Both are real, both are documented after disasters, and both are hospital-level care every time.

Where a prescription fits: it doesn’t. Both need hospital care.

One myth to put the kabosh on once and for all while we’re here. CDC states that floodwater exposure by itself does not create tetanus risk, and post-flood tetanus vaccination campaigns aren’t indicated.⁶ The risk rides on the puncture wound, not the water, which is why the people who need current vaccination are the ones going in to clean up.

Where preparation really helps

Three of the four bacterial infections above need something no cupboard holds. Vibrio is surgical before it’s medical: pain out of proportion to the wound, erythema spreading while you watch it, bullae, or crepitus means an emergency department now, not a call in the morning, because early debridement is what changes the outcome.⁸ Legionnaires’ is pneumonia and needs the workup. Severe leptospirosis is Weil’s disease: jaundice, renal failure, hemorrhage.

What’s left is pretty narrow.

The influenza antiviral is the strongest case. Oseltamivir is approved for treatment within two days of symptom onset, and CDC is explicit that treatment shouldn’t wait for laboratory confirmation, because testing delays it and a negative rapid test doesn’t rule flu out.⁹ The barrier was never the test. It’s the clock and the prescriber, and after a hurricane those are the same problem.

The antiemetic matches the volume. Tier 1 is mostly norovirus, and norovirus sends people looking for care because of what they can’t keep down. Ondansetron doesn’t touch the virus and doesn’t need to.

The antibiotic is the narrowest. A wound that has become infected with spreading cellulitis, in a person who can’t reach care, with roads out and clinics closed. Not the abscess, which needs drainage rather than a pill.

All three are for emergency use only, after trying to reach a provider, and a patient has them at home because a licensed provider reviewed the request and wrote the prescription.

What appropriate medical preparation actually covers

Look at what worked in this article and it sorts into two piles. One is free and behavioral: gloves and boots, soap and water over sanitizer, a separate room for the person who’s vomiting, current tetanus before anyone hauls drywall. The other is out of reach: an IV, an operating room, a prescriber who can see you today.

Almost nothing sits between them. Three things do, and all three only work if they were in the house before the storm, which means someone prescribed them before the storm.

That band is the category, and it has a name: appropriate medical preparation. The clinical work happens ahead of time, by a licensed provider who reviews the request and writes the prescription, for bounded indications, for emergency use only after the patient has tried to reach care. It is in no way a replacement for primary care or an emergency department. It exists for the stretch when neither one is reachable, which after a hurricane runs days.

We’re a family company of medical doctors, physician assistants, and pharmacists, and we’d rather publish where the line falls than sell past it. If a patient asks what they should have at home before a storm and you’d rather not work through it in a visit that’s already full, you can send them to us at jase.com, where a licensed provider reviews every request and writes every prescription. We’ll keep publishing the criteria as we work them out.

The bottom line

The infections that actually follow a hurricane, flood, or wildfire come out ranked almost backward from the way preparedness content lists them. The top of the list is viral, it spreads because people are packed into one building, and it’s stopped by gloves, soap, separation, and cleaning with the right product. Three of the four bacterial infections in this article need a clinician, an IV, or an operating room.

The next time a patient asks what to have on hand before a storm, the first half of the answer is prevention, and it’s free. The second half is three prescriptions for three situations, and that’s a conversation to have before the season rather than during it.

Sources

1. Patrick R, Lee K, Kuan M, et al. Norovirus, COVID-19, and Influenza Outbreaks Among Residents and Staff Members at the Eaton Wildfire Evacuation Shelter, Pasadena, California, January-February 2025. MMWR Morb Mortal Wkly Rep 2026;75(26):337-342. https://www.cdc.gov/mmwr/volumes/75/wr/mm7526a2.htm 
2. Outbreak of Norovirus Illness Among Wildfire Evacuation Shelter Populations, Butte and Glenn Counties, California, November 2018. MMWR Morb Mortal Wkly Rep 2020;69(20). https://www.cdc.gov/mmwr/volumes/69/wr/mm6920a1.htm 
3. Lynch VD, Shaman J. Waterborne Infectious Diseases Associated with Exposure to Tropical Cyclonic Storms, United States, 1996-2018. Emerg Infect Dis 2023;29(8):1548-1558. Cryptosporidiosis 52% increase during storm weeks (95% CI 42%-62%); STEC 48% increase at lag week 1 (95% CI 27%-69%); Legionnaires’ disease 42% increase at lag week 2 (95% CI 22%-62%). https://wwwnc.cdc.gov/eid/article/29/8/22-1906_article 
4. Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 2017;65(12):e45-e80. https://academic.oup.com/cid/article/65/12/e45/4557073 
5. Watson JT, Gayer M, Connolly MA. Epidemics after Natural Disasters. Emerg Infect Dis 2007;13(1):1-5. https://wwwnc.cdc.gov/eid/article/13/1/06-0779_article 
6. CDC. Safety Guidelines: Floodwater. https://www.cdc.gov/floods/safety/floodwater-after-a-disaster-or-emergency-safety.html 
7. Leptospirosis Outbreak in Aftermath of Hurricane Fiona, Puerto Rico, 2022. MMWR Morb Mortal Wkly Rep 2024;73(35). Mean weekly cases 10.4 during the 15 weeks after the storm versus 2.9 during the prior 37 weeks. https://pmc.ncbi.nlm.nih.gov/articles/PMC11376507/ 
8. Vibrio vulnificus in Taiwan. Emerg Infect Dis 2004;10(8). Overall case fatality approximately 30%; 86% of patients with cutaneous lesions received surgical treatment. https://wwwnc.cdc.gov/eid/article/10/8/04-0047_article 
9. CDC. Influenza Antiviral Medications: Summary for Clinicians. https://www.cdc.gov/flu/hcp/antivirals/summary-clinicians.html

For Clinicians | Medication Exposed to Flood Water

The FDA Rule and Its One Exception

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

Today we are covering three things: what FDA actually recommends for water-exposed medication, the one exception and why two of your patients will quote you different rules about it, and what to do at the counter while the determination is still open.

This is not only a coastal question. The National Flood Insurance Program reports that 29% of its flood claims between 2014 and 2024 came from outside high-risk flood areas.¹ Add burst pipes and a creek that came up over a road, and it reaches practices nowhere near a hurricane track.

Does medication that touched floodwater have to be discarded?

Yep. All of it. FDA recommends discarding any drug that came into contact with flood or contaminated water, including drugs in their original containers with screw-top caps, snap lids, or droppers.² The same goes for medication kept somewhere other than its original bottle: a pill organizer, a baggie, a daily-dose box.

A consumer closure (like child-proof cap) is not a water barrier. It keeps out a curious 4-year-old. It was never built to exclude contaminated water, and FDA is explicit that a tight cap does not change the answer. CDC spells out the dosage forms FDA doesn’t: pills, pill organizers, liquids, drugs for injection, inhalers, and skin drugs.³ 

This is a discard rule rather than a stability calculation because of what was in the water. CDC’s position is that we don’t know exactly what is in floodwater at any given point in time.5 It can carry human and livestock waste, whatever was under the sink, whatever came out of the garage, and medical and industrial hazardous waste. These are pills someone swallows, and CDC ties eating or drinking anything floodwater touched to E. coli and Salmonella.5 FDA’s trigger is flood or unsafe municipal water, which is broader than flooding alone.

When can a flood-exposed medication still be used?

There is one exception. FDA writes it as a scenario rather than a rule, which is why it reads oddly:

“A drug may be needed to treat a life-threatening condition, but a replacement may not be readily available. Drugs exposed to fire or unsafe water should be replaced as soon as possible. If the drug looks unchanged – for example, pills in a wet container appear dry – the drugs can be used until a replacement is available. If the pills are wet, then they are contaminated and need to be discarded.”²

Read as a rule, all three have to be true:

1. The indication is life-threatening.
2. A replacement is not readily available.
3. The product looks unchanged.

FDA never calls the drug safe. It says exposed drugs may be contaminated, then says a life-sustaining one can be used anyway until a replacement arrives. That’s bridge therapy: once the replacement is in hand, the exposed product gets discarded.

Cost is not one of the three. It’s a real access barrier and it should change how fast you move on a replacement. It doesn’t change whether a contaminated bottle stays in use.

Why the same guidance reaches patients two ways

CDC’s full guidance lines up with FDA’s, and on the stop rule it’s much clearer: take the lifesaving drug if it looks normal and dry, and “stop taking them as soon as replacement medication becomes available.”4

What reaches the public isn’t that page. CDC writes the same guidance as a text-message blast and a television news crawl, and at that length it becomes: “You can use lifesaving drugs stored clean and safe if they look normal and dry.”3 One sentence. Nothing about whether a replacement is available, nothing about when to stop.

So you get two patients working from the same agency. One saw the crawl during storm coverage and figures dry pills settle it. The other read the full page article and knows appearance is the last thing you check, after the drug is life-sustaining and after there is nothing available to replace it. Both got federal guidance.

Appearance is the only condition a patient can check without us. It is also the one that matters the least.

What to do at the counter or clinic

Quarantine rather than discard while the determination is open. Label it clearly as “NOT FOR USE” and keep it separate from everything else. That protects in both directions: you are not throwing out products the patient may have real trouble replacing, and you are not leaving a questionable bottle within reach while the question is still open.

Then give an interim instruction, because “set it aside” is not an instruction until the patient knows what to do about tonight’s dose. Working as a pharmacist I’d say, “Don’t take anything out of that bottle. I’m working on a replacement today and I’ll call you before your next dose is due.“

Document the exposure, what you consulted, the determination you reached, the interim instruction, and when a pending determination closes. An undocumented determination didn’t happen.

For emergency medication replacement when it is hard to reach the provider, check whether your board has issued an emergency dispensing notification. Texas issued one on July 7, 2025 for the Hill Country flooding, authorizing pharmacists to dispense up to a 30-day supply of non-Schedule-II drugs without prescriber authorization for patients in the declared counties.6

The authorization carries conditions. Tell the patient the refill is going out without prescriber authorization and that future refills need it, notify the prescriber at the earliest reasonable time, and keep a record. If the prescription was originally filled somewhere else, the patient needs the container, label, receipt, or other documentation, and you need to have tried to transfer it first.⁶

Mixing a suspension under a boil-water notice

This one’s interesting because no flooding is required. Any time there’s a boil-water notice, medication that needs to be reconstituted gets purified or bottled water only.² And you’re thinking, “The water’s boiled, that was the entire point of the notice! It should be fine…” Maybe. The FDA names purified and bottled and stops there. Boiled tap isn’t on the list, and the guidance never says whether it counts, so the instruction that holds up is FDA’s own: bottled or purified. A simple way to communicate this to patients is: “Don’t mix it with tap water, even boiled. Bottled water only until the notice lifts.”

The powder is a separate question from the water. Sealed and dry, it’s fine, and what you add is the only thing to sort out. If the bottle or the powder itself was in contact with flood or unsafe water, we’re back to the discard rule at the top.

The middle step nobody has built

After water reaches the cabinet, our patients have 2 options and both are bad. Throw everything out and go without until somebody can be reached, or keep it and hope. There is no sanctioned step in between, and that step is the part that needs a clinician: an actual determination, made by someone who knows which of the 3 conditions apply.

That determination is what appropriate medical preparation looks like here. It is not a supply question. Two things that cost a patient nothing before any water shows up, and both sit in FDA’s own guidance: a written list of every prescription with drug, dose, prescriber, and pharmacy, and the bottles kept inside a water-tight container with a lid.² That written list isn’t only for you. A displaced patient seeking an emergency refill at a pharmacy that didn’t fill the original needs exactly that documentation to get one.⁶ Then the determination itself, made with us instead of guessed at off whatever version of the guidance reached them first.

This complements primary care rather than replacing it. We are here for the stretch when primary care is not reachable, which after a flood runs days.

For the acute problems a flood actually produces, the wound care and the infections, we keep contingency medication available for patients whose providers would rather refer than build that conversation from scratch. A licensed provider reviews every request and writes every prescription, and that medication is for emergency use only, after first seeking help from a qualified provider.

We will keep publishing the frameworks as we work them out, including the ones where the full guidance and the short version patients actually see don’t line up.

The bottom line

If it touched flood or unsafe water, discard it. That includes the bottle with the tight cap and the tablets that look perfect. The only route to keeping it is a life-threatening indication, no replacement available, and no visible change, and the exposed product gets discarded once the replacement is in hand. Quarantine while you sort it out, write down what you decided, and reconstitute with bottled water only.

The patient in front of you may have already made this call without us. Ask what got wet and where it was, not how it looks.

Sources

1. Federal Emergency Management Agency, National Flood Insurance Program. What is My Flood Risk. https://www.floodsmart.gov/flood-zones-and-maps/what-is-my-flood-risk. Retrieved August 17, 2026.
2. U.S. Food and Drug Administration. Safe Drug Use After a Natural Disaster. https://www.fda.gov/drugs/emergency-preparedness-drugs/safe-drug-use-after-natural-disaster. Content current as of August 28, 2019. Retrieved August 17, 2026.
3. Centers for Disease Control and Prevention. Drugs Exposed to Water. Natural Disasters public service announcement toolkit. Quoted line appears under Text Messages for Mobile Devices and Related Television Crawls for News Media. https://www.cdc.gov/natural-disasters/psa-toolkit/drugs-exposed-to-water.html. Last updated February 7, 2024. Retrieved August 17, 2026.
4. Centers for Disease Control and Prevention. Lifesaving Drugs. Natural Disasters public service announcement toolkit. https://www.cdc.gov/natural-disasters/psa-toolkit/lifesaving-drugs.html. Last updated February 6, 2024. Retrieved August 17, 2026.
5. Centers for Disease Control and Prevention. Safety Guidelines: Floodwater. https://www.cdc.gov/floods/safety/floodwater-after-a-disaster-or-emergency-safety.html. Last updated February 6, 2024. Retrieved August 17, 2026.
6. Texas State Board of Pharmacy. Hill Country Flooding: Emergency Dispensing of Prescription Medications. Issued July 7, 2025. Authorized under Texas Pharmacy Act Sec. 562.054 and Board rule 291.34(b)(8)(E). https://www.pharmacy.texas.gov/files_pdf/2025-Flood-Notification.pdf. Retrieved August 17, 2026.

For Clinicians | 2024 First Aid Guidelines

What Changed, and What Your Patients’ Kits Still Get Wrong

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

Your patient bought their first aid kit off an endcap, or from whichever online checklist looked credible. Nobody clinical was standing beside them when they did it. Pharmacists, go look at the kit on your own shelves this week. There’s a good chance it has hydrogen peroxide in it.

Patients tend to assume that buying a first aid kit means they are covered. “Well, it’s better than nothing!” They read a list, buy the box, put it under a truck seat or in a closet, and do not open it again until something goes wrong.

In 2024, the American Heart Association and the American Red Cross published the first comprehensive revision of first aid treatment recommendations since 2010¹. Yet some retail kits still ship to the previous standard and online search results still describe the outdated items.

For a quick real life example, take good ol’ baby aspirin. Many patients still have an 81- mg bottle in the cabinet, and that may be the bottle they’ll grab when a family member’s chest starts hurting. But one 81 mg tablet is below the dose the guidelines recommend in suspected cardiac chest pain. Fixing that takes fifteen seconds in the office or at the counter.

This article covers several changes in the 2024 guidelines, a few common beliefs patients’ kits continue to reinforce, and the larger preparedness gap that first aid guidelines were never designed to fill.

What changed in the 2024 first aid guidelines?

The 2024 document is the first comprehensive revision since 2010, following focused updates in 2015, 2019, and 2020.¹ The writing group identified several new or substantially revised topics: opioid overdose, bleeding control, open chest wounds, spinal motion restriction, hypothermia, frostbite, presyncope, anaphylaxis, snakebite, oxygen administration, and pulse oximetry, with pediatric guidance where it applies.¹ Earlier recommendations remain in effect unless the 2024 document specifically updates them.

Two of those changes reach into the box your patients already own.

Bleeding control: One manufactured windlass tourniquet is now a line item in the Red Cross minimum contents table for a first aid kit.² Not a tactical upgrade. The minimum. But putting one in the kit is only useful if the patient knows when and how to apply it.

Opioid overdose: When a person with a suspected opioid overdose is unresponsive and not breathing normally, the guidelines call for activation of EMS, high-quality CPR with compressions and ventilation, and naloxone.¹ Those actions may overlap. Naloxone is not in the minimum contents table.²

Nobody owns the seam

Those updates reveal a larger problem. Patients do not separate first aid, disaster preparedness, and medication planning. They expect one kit to cover all three. Four quick corrections can make the kit more useful, but they also show where its limits begin.

Two separate bodies of guidance address different parts of the same household emergency plan.

• On the injury side, the first aid guidelines and Stop the Bleed address immediate care: direct pressure, wound packing, and tourniquet use.³ No mention of prescriptions.
• On the disaster side, the federal preparedness guidance tells families to keep a written medication list with diagnosis, dosage, frequency, supply needs and allergies, plus a cooler for anything requiring refrigeration.⁴ It says little about how to effectively irrigate a wound or control severe bleeding.

Nobody at home is sorting injury guidance from disaster guidance. There’s one box on hand, and they expect it to cover whatever comes up. 

Patients ask what’s reasonable to keep at home, and neither body of guidance tells you as the provider or pharmacist what’s reasonable to authorize in advance, or where the boundary sits between preparing a patient and writing an inappropriate prescription.

Quick reference: four corrections

Four points cover much of what patients need to know when this subject comes up in the clinic or at the pharmacy counter.

Three involve time-sensitive emergencies in which the right response can save a life. The peroxide correction is less dramatic, but it can prevent avoidable tissue injury and delayed healing.

The layer the kit was never built to hold

This next part is not strictly a first aid question, which is why no first aid guideline answers it.

Some families have the pill bottles and nothing useful for a wound. Others have gauze for days and no plan for the medications they take every morning.

Household medical preparedness has at least three layers. The first is immediate first aid: the supplies and skills used for bleeding, burns, wounds, sprains, and other acute problems. The second is continuity: current chronic prescriptions, an updated medication and allergy list, and a plan for storage or refrigeration.⁴ The third is individualized contingency planning for predictable problems when timely care is unavailable. In selected cases, that may include short-course medication prescribed in advance after a licensed clinician reviews the patient and provides condition-specific instructions.

That third layer is not part of the AHA/Red Cross first aid guidelines. It is a separate clinical decision, and stored medication should be used only under the instructions provided and when qualified medical assistance cannot be reached promptly.

The missing clinical layer

Underneath all four corrections is a structural problem. A household gets one of two things: they reach a clinician, or they work with whatever is in a box assembled to someone else’s checklist. Little formal guidance addresses the space between those options, which is how an endcap product ends up deciding what a family has on hand when something goes wrong.

That clinical layer has a name: individualized medical preparation. It is work completed before an emergency for a limited set of circumstances that may not wait for business hours.A tourniquet and naloxone illustrate the broader principle that useful emergency interventions must often be obtained—and understood—before they are needed. The first aid guidelines do not extend that principle to advance prescribing, but they demonstrate why preparation matters.

This is not a replacement for primary care. Complex diagnoses, ongoing conditions, and clinical uncertainty belong in the exam room. The appropriate role of advance planning is narrower: a defined set of circumstances, a patient screened in advance, clear instructions, and a plan for what requires direct care.

If you’d rather refer

Some of you would rather not write for this at all, which is a reasonable place to land. When a patient asks and you don’t want to be the one deciding what’s appropriate to keep on hand, send them to us at Jase.com. A licensed provider reviews every request and determines if a prescription is appropriate, so the referral is a clinical handoff and not a way around a visit.

We’ll keep publishing where we draw lines, what evidence we’re using, and the criteria behind a no. If we’re going to name a clinical category, the framework should be public enough for other clinicians to scrutinize and argue with.

The bottom line

The guidelines moved in 2024, but many patients’ kits did not move with them. An emergency is the wrong time to discover that the aspirin instructions are incomplete, the tourniquet is missing or unfamiliar, or the only wound cleaner in the box is peroxide.

Tell your patients to spend fifteen minutes with the kit they already own. Check the dates, replace what’s expired, take out what doesn’t belong in a wound, and make sure they know how to use what remains. They may not need a bigger kit. They need a current one and a plan they understand.

Sources

1.  Hewett Brumberg EK, Douma MJ, Alibertis K, et al; American Heart Association and American Red Cross. 2024 American Heart Association and American Red Cross Guidelines for First Aid. Circulation. 2024;150(24):e519-e579. 
2. Minimum Contents for American Red Cross First Aid Kit, Table 2, 2024 AHA and American Red Cross Guidelines for First Aid. cpr.heart.org 
3. Stop the Bleed. American College of Surgeons Committee on Trauma. stopthebleed.org 
4. Tips for Medication. Ready.gov, Federal Emergency Management Agency.
5. Wound Home Care. American College of Surgeons. facs.org 
6. FDA Approves First Over-the-Counter Naloxone Nasal Spray. US Food and Drug Administration, March 29, 2023.

For Clinicians | Emergency Preparedness in Older Adults

The Three Parts That Are Yours

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

Most of your patients over 55 are doing well. Pickleball four mornings a week, a cruise booked for October, a flight out to see the grandkids.

Then something changes the math. A first prescription for blood pressure or thyroid or a statin. A fall that took a lot longer to come back from than it would have at 40. A hospitalization nobody saw coming. Nothing catastrophic, but important enough to stay with them, and afterward a question shows up that never occurred to them at 30: what would I do if I couldn’t get to care?

At 30 nobody asks that. You take nothing, and you have never once considered slipping on your own front steps. By 60 it’s a pertinent question that is top of mind and being discussed at games on the court, on the deck of the ship, and with a whole peer group running the same arithmetic. “What if I can’t get this medication anymore? What if I get hurt again and am far from care?”

So they prepare, off the same checklist a 30-year-old would use. She isn’t going to bring that medical preparation to you as her clinician or pharmacist. Three parts of this prep are yours anyway: how long a fill she can get on the prescriptions she already takes, whether the medication reference list in her bag is sufficient, and what she decides to keep on hand for the illnesses that haven’t happened yet.

We’re a team of physicians, PAs, and pharmacists, and we field this question constantly from patients in exactly that age band. Today we’re covering what makes appropriate medical preparation different for this age group than for any other.

Your patients are already preparing, and it’s happening without us

This is not behavior we need to talk anyone into. In a 2019 national poll of adults 50 to 80, 82% said they had a week’s supply of their medications on hand, and 72% had a week of other health supplies.¹ Three-quarters had lived through at least one major emergency in their lifetime. Fewer than a third had actually assembled an emergency kit, and among the patients who depend on electrically powered medical equipment, only one in four had backup power.

So the intent is close to universal and the execution is uneven. The medication half is the part they’ve done best, which makes sense, because it’s the part they already think about every morning.

Then there’s the number that should get our attention. Only 40% had discussed their emergency plans with their own family. If six in ten haven’t raised it with the people they live with, the odds they raised it at their annual visit are worse. The planning is happening, the supplies are being bought, the medication list is being written, and no clinician or pharmacist has looked at any of it.

What makes their preparation different is that it’s mostly a medication problem

For most people under 40, preparation is a supply question. Water, food, a flashlight, a first aid kit, plus some way to hear what’s happening. Medication appears on those checklists, but it isn’t what they’re built around, and for a healthy 30-year-old that doesn’t take any chronic meds it is the right call.

It stops being the right call somewhere in the late fifties. Polypharmacy in adults 65 and older climbed from 23.6% in 1999 to 2000 up to 43.0% by 2017 through March 2020, and the average number of prescriptions per person went from 3.0 to 4.3.² In twenty years, taking five or more prescription medications went from about a quarter of this population to nearly half of it.

So her grandson’s version of this and her’s are not the same exercise. His is bandages, ibuprofen, and a flashlight. Hers is four or five prescriptions she can’t skip for a week, plus everything on his list.

And her four or five medications she does take are not equal, which is the part she may not be able to differentiate on her own. A week without a statin is a non-event. Levothyroxine has enough half-life to forgive a few missed days. A beta blocker stopped abruptly is much more time-sensitive. So are anticoagulants, antiepileptics, and insulin. It’s easy to treat all of them as one undifferentiated pile labeled ‘my medications.’ Sorting that pile into what tolerates a gap and what doesn’t only take 2 minutes and helps flag what is most important to have enough of hand on to prevent a disruption in care.

Part one: how long a fill she can get

Let’s take the easiest of the three first. When a patient asks whether she can get more of a medication she already takes, that’s a dispensing-interval question. Same drug, same dose, same indication, same prescriber. Only the interval changes, and nothing about her pharmacologic exposure does. That is, speaking for general chronic medications. This isn’t the same for controlled substances or acute cases like antibiotics.

So write it long. For a patient who’s worried, you can write a year of refills on a chronic medication up front and let her decide how much to have on hand at any one time. She can pick up a month, or three, or the whole year if her plan allows it. Some plans will cover a full year at once for travel, which is worth asking about rather than assuming.

If you do nothing else with this article, default your chronic prescriptions to 90 days. Your patients end up with a real amount on hand without anyone having to plan for it, and they stop driving to the pharmacy and standing in line twelve times a year for a medication that hasn’t changed in a decade.

Part two: the list in her bag

The AGS tip sheet says to carry a written medication list that contains all brand and generic names and doses a patient takes regularly.³ That’s the right instruction, and it’s the one she’s most likely to have done badly, because most people don’t have this written down and just cite it from memory. What comes out is “the little white one for blood pressure” and a dose she’s half sure about. And to make matters more complicated many patients pharmacy shop for the best price on medications so the Rx are spread across pharmacy chains and multiple prescribers with no central EMR hub all healthcare professionals can access.

A clearly printed, and accurately updated med list is usable by a pharmacist who has never met her. Drug, strength, and directions for each item, and the condition each one treats. Indication is important to remember and not leave off either. Add her allergies, adverse reactions to previous medications, and your office phone number while you’re at it.

This simple list costs almost nothing. Your MA can print the med list at check-out in a minute. Just make sure to add the medications prescribed by other HCPs she sees. Better than that, have her ask her pharmacy(ies) for a printed profile, because the dispensing record shows what she has actually been filling and when, which is often closer to the truth than what’s in the chart. Reconciling those two against each other is the whole exercise that is most helpful. If they disagree, you and she have learned something worth knowing whether or not a disaster ever shows up.

Part three: what she keeps on hand for what hasn’t happened yet

This is the part that earns the skepticism, and it’s also the part where the answer moves with the decade. A healthy 58-year-old on one antihypertensive is not a Beers patient⁴. A 78-year-old on four medications, with a creatinine clearance you’d want in front of you first, is a different conversation. The difference isn’t age by itself. It’s the list she’s already on.

A single new drug isn’t generally a big deal.  It’s when another is added to a polypharmacy list that there’s more for it to bump into for drug-drug interactions and drug-condition interactions. And the kidneys are slower, so the same dose hits harder. The 2023 Beers criteria are still current as of this summer if you want the reference.

And, since we are talking about appropriate medical preparation, if she’s in a situation where she can’t reach a healthcare professional she’s the one who decides whether to take it with nobody to ask. The bottle won’t tell her when not to. You will, ahead of time, while she’s feeling fine. Anything she keeps on hand is for an emergency, after she’s tried to reach a provider, and she only knows that because somebody told her. That’s the argument for having the conversation about how to prep well instead of saying no and sending her to figure it out herself with the internet chat rooms as guide.

The drug-by-drug version of what medications are appropriate for seniors in emergency kits is its own article and we’re writing it: what to look for in medical preparation after 70, and which contents actually matter at that age. 

The missing middle layer

Here’s the structural problem underneath all three parts. Care in this country is all or none. Either she reaches a clinician and gets a prescription, or she’s on her own with whatever happens to be in the house. Nothing sanctioned sits in between, which is how a reasonable 64-year-old asking a reasonable question ends up choosing between a no from her prescriber and whatever she finds on her own.

Appropriate medical preparation is the name for that middle layer. One bounded step, taken ahead of time, by a clinician, for the disruptions that actually happen to people her age: the week she can’t get to the pharmacy, the storm, the trip that puts her four hours from a clinic. Or international travel.

It isn’t a replacement for the clinician or the pharmacist she already has. It doesn’t manage her chronic conditions, it doesn’t follow her labs, and it makes no decision at the point of use. It’s what’s on the shelf for the times you aren’t reachable, used in an emergency, after she’s tried to reach someone.

If a patient in that age band asks and you’d rather not be the one to build an appropriate medication kit with her, you can send her to us at Jase.com. A licensed provider reviews every request and writes every prescription, so it’s a handoff rather than a workaround.

We’ll keep publishing where we draw the lines, including the lines that run through our own products. Right now that conversation is happening on the pickleball court with nobody clinical in it. That’s the part we’re trying to fix.

Sources

1. National Poll on Healthy Aging. Emergency Planning among Older Adults. University of Michigan Institute for Healthcare Policy and Innovation, with support from AARP and Michigan Medicine. Fielded May 2019, published September 4, 2019. n = 2,249 adults ages 50 to 80. https://www.healthyagingpoll.org/reports-more/report/emergency-planning-among-older-adults
2. Innes GK, Ogden CL, Crentsil V, Concato J, Fakhouri TH. Prescription Medication Use Among Older Adults in the US. JAMA Internal Medicine. 2024;184(9). NHANES, January 1999 through March 2020, 14,917 adults aged 65 and older. Polypharmacy, defined as 5 or more prescription medications, rose from 23.6% to 43.0%; mean medications per person rose from 3.0 to 4.3. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2820722
3. American Geriatrics Society. Tip Sheet: Emergency Preparedness for Older Adults. HealthInAging.org, September 2019. https://www.healthinaging.org/tools-and-tips/tip-sheet-emergency-preparedness-older-adults
4. By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society. 2023;71(7):2052-2081. doi:10.1111/jgs.18372. https://pubmed.ncbi.nlm.nih.gov/37139824/