# SAFETY

# 

## Hurricane Katrina Relief \-- Safety Considerations for Incoming Support Personnel

The mission of the Forest Service and cooperating agencies under the
National Response Plan is to support the federal government's effort to
bring emergency relief supplies to the storm damaged areas. As requested
by the Federal Emergency Management Agency (FEMA), the Forest Service
provides logistical support such as managing base camps for field
hospitals, receiving and distributing trucks and aircraft with relief
supplies and managing the care, feeding and logistical support of
thousands of relief workers and elderly infirmed care for persons unable
to evacuate workers and volunteers. This is life-sustaining work to the
hundreds of thousands of Americans impacted by the recent storm.

Much of the work tasked is novel to the Forest Service and our partner
agencies that have expertise in forest and range "wildland" management.
Due to the novelty of the work, special safety considerations must be
given.

**[Prior to Departure from your Home Unit]{.underline}:**

Obtain as much information as possible concerning expected living
conditions. If you are ordered to a coordination center, you will likely
have access to telephone service, restaurants and hotel lodging. If you
are ordered to a logistical support center or other "field assignment"
you may be living and working under primitive conditions.

**[Safety Considerations for Persons Ordered to Field
Assignments]{.underline}:**

Expect that you are going into a desperate situation. For the duration
of your tour, plan on no electricity, no refrigeration and no telephone
communications. In contrast to a "fire camp" you should assume that
there will be no Supply Unit available. Therefore bring with you the
following:

-   fresh refill of any necessary prescriptions

-   three MREs or other non-perishable meals

-   a tent

-   rain gear

-   insect repellent

-   light sleeping bag

-   flashlight and extra batteries

-   hard hat

-   gloves

-   first-aid kit with aspirin, Band-Aids, etc.

-   sleeping pad if you have room.

-   cash -- (credit cards require phone lines)

-   portable water purifier

If you are driving, bring a few cases of water with you. If flying in,
purchase extra water when you have the opportunity.

## General INCIDENT RISK ANALYSIS for Hurricane Support

+-----------------+----------------------------------------------------+
| **HAZARDOUS     | **MITIGATIONS/WARNINGS/REMEDIES**                  |
| ACTIONS OR      |                                                    |
| CONDITIONS**    |                                                    |
+-----------------+----------------------------------------------------+
| 1.              | Alert all personnel to the threat of dehydration   |
|                 | and the symptoms of heat stress. Caution personnel |
| **PERSONNEL     | to allow time (days) to acclimate to high          |
| WELFARE, HEAT   | humidity. Follow work/rest ratio.                  |
| STRESS &        |                                                    |
| DEHYDRATION AND |                                                    |
| FATIGUE**       |                                                    |
|                 |                                                    |
| **DISEASE?**    |                                                    |
+-----------------+----------------------------------------------------+
| **TRAVEL,       | -   In storm impacted areas do not depend on cell  |
| GETTING LOST,   |     or land-line coverage. If you get lost, stuck  |
| STUCK, OUT OF   |     in the mud or high water, or trapped by fallen |
| GAS, OUT OF     |     power lines or trees it may be a very long     |
| CELL            |     time before being found.                       |
| COVERAGE**.     |                                                    |
|                 | -   Expect gasoline shortages or pumps not working |
|                 |     in storm impacted areas.                       |
|                 |                                                    |
|                 | -   Travel consideration for driving through storm |
|                 |     impacted areas:                                |
|                 |                                                    |
|                 | -   Carry at least \$100 per person in cash or     |
|                 |     traveler's checks (in areas of power outages,  |
|                 |     credit cards will likely not be accepted)      |
|                 |                                                    |
|                 | -   Refill gas tank at ½ empty.                    |
|                 |                                                    |
|                 | -   Travel with 2+ persons/vehicle on trips        |
|                 |     greater than 2 hours.                          |
|                 |                                                    |
|                 | -   Check air pressure in spare tire prior to      |
|                 |     departure.                                     |
|                 |                                                    |
|                 | -   Ensure positive ETA and ROUTE information is   |
|                 |     conveyed to a contact person at your           |
|                 |     destination or your supervisor. Ensure the     |
|                 |     contact person / supervisor will initiate a    |
|                 |     search along your intended route if you don't  |
|                 |     arrive within a pre-specified time limit.      |
|                 |                                                    |
|                 | -   Confirm that all personnel do not begin travel |
|                 |     unless they have enough water, non-perishable  |
|                 |     food and necessary Prescriptions etc., to be   |
|                 |     entirely self sufficient for 48 hours.         |
|                 |                                                    |
|                 | -   Continuously listen to local radio stations    |
|                 |     (not satellite stations, rebroadcast stations, |
|                 |     CD's, tapes etc,) for weather alerts,          |
|                 |     evacuation notifications, washed out roads,    |
|                 |     and gasoline status information                |
+-----------------+----------------------------------------------------+
| ######          | -   Utilize only licensed and qualified drivers.   |
|                 |     Note Region 8 requires a Government Motor     |
| DRIVING \~ RISK |     Vehicle Operator's ID card for all persons     |
| OF COLLISIONS.  |     operating an owned or rented vehicle.          |
|                 |                                                    |
| ######          | -   Drivers may not use cell phones when moving.   |
|                 |                                                    |
|                 | -   Adhere to incident driving guidance (rest      |
|                 |     requirements) found in the interagency         |
|                 |     incident business management handbook.         |
|                 |                                                    |
|                 | -   Pre-plan route and avoid local roads.          |
|                 |                                                    |
|                 | -   Drive only during daylight hours in areas      |
|                 |     storm impacted areas.                          |
|                 |                                                    |
|                 | -   When driving in storm-impacted areas, brief    |
|                 |     drivers on caution for confused deer, loose    |
|                 |     livestock, flooded low areas, washed out       |
|                 |     culverts and bridges that may have undercut    |
|                 |     foundations, inoperable traffic lights, blown  |
|                 |     down stop signs and debris in roadways.        |
+-----------------+----------------------------------------------------+
| ####            | All personnel will have adequate foot gear (no     |
|                 | open shoes) and rain parkas or rain suits.         |
| **EXPOSURE TO   | Additional PPE may be required at work areas.      |
| ENVIRONMENTAL   | Prior to entering a work area, obtain a briefing   |
| ELEMENTS,       | from the official in charge pertaining to required |
| VARIOUS WORK    | PPE and other safety information. See Emergency    |
| HAZARDS**       | Stabilization JHA.                                 |
+-----------------+----------------------------------------------------+
| **DESPERATE     | Avoid stopping except in secure locations. If you  |
| SURVIVORS**     | are forced to stop, remain calm and be compliant   |
|                 | with requests. Do not put yourself in danager by   |
|                 | trying to defend your belongings or vehicles. Get  |
|                 | out of the situations as quickly as possible.      |
+-----------------+----------------------------------------------------+
| **C             | Out side of incident radio coverage area, carry a  |
| OMMUNICATIONS** | cellular phone but do not depend on cell coverage  |
|                 | being available even in cities.                    |
+-----------------+----------------------------------------------------+
| **AIRCRAFT OR   | Only qualified personnel will work around          |
| FLYING**        | aircraft. If flying in contract aircraft, ensure   |
|                 | pilot and aircraft are currently certificated and  |
|                 | obtain a preflight briefing from the pilot.        |
+-----------------+----------------------------------------------------+

+-----------------+----------------------------------------------------+
| **HAZARDOUS     | > **MITIGATIONS/WARNINGS/REMEDIES**                |
| ACTIONS OR      |                                                    |
| CONDITIONS**    |                                                    |
+-----------------+----------------------------------------------------+
| **POISONIOUS    | > See **Southeast (live) Watchouts document for    |
| INSECTS/        | > listing.** Utilize common mitigation measures-   |
| SPIDERS/        | > avoidance of usual habitat; look up- down and    |
| CATAPILLARS/    | > around prior to proceeding. Where appropriate    |
| SNAKES/         | > protective clothing. Utilize repellents. Special |
| PLANTS-NUISANCE | > considerations:                                  |
| INSECTS, BEES** | >                                                  |
|                 | > After a flood, storms, or hurricane, snakes are  |
|                 | > forced into places where they usually are not    |
|                 | > found. Take the following precautions if you     |
|                 | > live in an area where poisonous snakes are       |
|                 | > common.                                          |
|                 |                                                    |
|                 | 1.  Know how to identify poisonous snakes common   |
|                 |     to your area.                                  |
|                 |                                                    |
|                 | 2.  Be alert for snakes in unusual places. They    |
|                 |     may be found in or around homes, barns,        |
|                 |     outbuildings, driftwood, levees, dikes, dams,  |
|                 |     stalled automobiles, piles of debris, building |
|                 |     materials, trash, or any type of rubble or     |
|                 |     shelter.                                       |
|                 |                                                    |
|                 | 3.  Keep a heavy stick or some other weapon handy. |
|                 |                                                    |
|                 | 4.  Search the premises thoroughly for snakes      |
|                 |     before beginning any cleanup or rescue         |
|                 |     operations. Snakes may be under or near any    |
|                 |     type of protective cover.                      |
|                 |                                                    |
|                 | 5.  In rescue or cleanup operations, wear heavy    |
|                 |     leather or rubber high-topped boots, and heavy |
|                 |     gloves. Wear trouser legs outside boots. Be    |
|                 |     extremely careful around debris. Use rakes,    |
|                 |     pry bars, or other long-handled tools when     |
|                 |     removing debris. Never expose your hands,      |
|                 |     feet, or other parts of your body in a place   |
|                 |     where a snake might hide.                      |
|                 |                                                    |
|                 | 6.  Carry a strong light after dark                |
+-----------------+----------------------------------------------------+
| > **POWER       | > Assume all power lines are hot unless positive   |
| > LINES**       | > confirmation is received to the contrary from a  |
|                 | > qualified electrician or utility company         |
|                 | > representative. Caution employees that household |
|                 | > generators may transmit power back through power |
|                 | > lines.                                           |
+-----------------+----------------------------------------------------+
| >               | > Assume all water is contaminated unless you saw  |
|  **CONTAMINATED | > the bottle it came from. Municipal water         |
| > WATER**       | > supplies in severely storm damaged areas are     |
|                 | > also likely contaminated.                        |
+-----------------+----------------------------------------------------+
| > **ADDITIONAL  | > Monitor local forecasts and warning/watch        |
| > STORMS/HUR    | > alerts. Follow local evacuation/shelter          |
| RICANES/FLOODS/ | > protocols from local officials.                  |
| > LIGHTNING**   |                                                    |
+-----------------+----------------------------------------------------+

##  Live Watchouts:

**[Poisonous Insects:]{.underline}** (pictures can be found at:
[http://edis.ifas.ufl.edu/BODY_IG099 -
TABLE_2](http://edis.ifas.ufl.edu/BODY_IG099#TABLE_2))

-   **Wheel Bug**: looks like a wood borer, has a cog-like wheel on
    thorax, dark gray, with a red biting mouth that injects a painful
    venom.

```{=html}
<!-- -->
```
-   **Fire ants**: one or two bites annoying but they swarm when the
    mound is disturbed. Flooded fire ant colonies are "disturbed" and
    will swarm together and float to a dry area or tree canopy to escape
    water.

-   **Vinegaroon**: Resembles a scorpion but without a stinger. Instead
    of stinging, the vinegaroon will spray its victim with an acidic
    substance that can cause painful eye irritation.

-   **Scorpion**: not as poisonous as western species but may be
    extremely painful. Florida scorpions are considered non-poisonous.

-   **Assassin** (kissing) **bug**: can be black and white or bright
    orange. Injects venom through a slender mouth tube. Extreme pain
    associated with bites.

-   **Centipede**: "Centa" meaning hundred (not as many legs as a
    *milli*pede). Poisonous front claws. Similar to a bee sting and
    similar potential for an allergic reaction.

-   **Giant Water Bug**: Large flat brown bug that can both swim and
    fly. Injects victim with a tissue dissolving venom that caused
    extreme pain and inflammation below the bite.

-   **Blister Beetle**: Ranges from black to gray, striped to brightly
    colored. Excretes juices that caused skin to blister. These "juices"
    contain cantharidin, one of the most toxic compounds produced by
    animals. Don't eat these bugs. Cows have been know to have died from
    eating hay containing these beetles.

**[Poisonous Spiders:]{.underline}**

-   **Black** (southern black widows tend to be more brownish)
    **Widow**: Common across the country distinctive red hourglass on
    underside. Always seek medical attention if bitten.

-   **Brown Recluse:** Likewise common across the country, faint to
    distinctive violin shaped mark on head. Likewise always seek medical
    attention if bitten.

**[Poisonous Caterpillars:]{.underline}** These caterpillars shed fine
spines when handled. These 5 have venom sacs connected to their spines
that can be very painful and get infected. The spines can be removed
with duck tape.

-   **Saddleback caterpillar**: Distinctive light green saddle on back
    with a brown spot in the middle.

-   **Io Caterpillar**: 2 inches long, pale green with yellow stripes.

-   **Puss Caterpillar**: 1 inch long and white to tan and common, looks
    like a pussy-willow head. The venom from the spines is one of the
    most toxic substances produced by animals. If the pain is intense,
    you've got a good dose and should seek medical attention.

-   **Slug Moth Caterpillar**: Colorful green and tufts of fine spines.

-   **Buck Moth Caterpillar**: Black with red fine spines.

**[Poisonous Snakes:]{.underline}** (an online guide to snake
identification can be found at:
<http://www.flmnh.ufl.edu/natsci/herpetology/fl-guide/venomsnk.htm>)

-   **Cottonmouth**: Olive brown to black, grows up to 5 feet long, fast
    swimmer and can strike from water. Very common near, in, or over
    fresh water. Always seek medical attention if bitten.

-   **Copperhead**: Tan to golden, usually less than 3 feet long,
    reclusive, nocturnal hunter. Always seek medical attention if
    bitten.

-   **Coral snake**: North America's most toxic! banded black, yellow &
    red; "red next to yellow will kill a fellow". Bite does not leave
    fang marks. Always seek medical attention if bitten.

-   **Canebrake Rattlesnake**: Up to 5 feet long, gray-brown, likes
    swampy areas in the summer. Always seek medical attention if bitten.

-   **Pigmy Rattlesnake**: Adults are only 18 inches long, gray to
    brown, very aggressive and will chase you when disturbed. Always
    seek medical attention if bitten.

-   **Diamondback Rattlesnake**: Up to 8 (eight) feet long, yellow to
    brown diamond shaped patterns on back; aggressive and know to not
    rattle prior to striking, also known to strike repeatedly. Always
    seek medical attention if bitten.

**[Megga-fauna:]{.underline}**

-   **Alligator** and in extreme southern Florida, **Crocodile**: Just
    stay away.

-   **Black Bear** and **Wild Boar** locally common, and rarely **Bob
    Cat**, and **Cougar**: Just stay away. Boars will chase you and even
    charge groups of people.

**[Plants:]{.underline}**

-   **Poison Ivy & Poison Sumac**: Everyone knows poison ivy but
    westerners may not recognize poison sumac. It looks very similar to
    western sumac but the berries are white-ish and are throughout the
    bush. Poison sumac contains the same chemical, *urushiol* as does
    poison ivy

**[Nuisance Insects:]{.underline}**

-   **Mosquito**: West Nile Virus, Eastern Equine Encephalitis & St.
    Louis Encephalitis; are the three worst diseases potentially
    transmitted to humans by mosquitoes in the southeast.

-   **Chigger**s: Welcome to the south ya'll! Always pronounced in the
    plural form and you'll find out why. While not know to transmit
    diseases, these \"red bugs\" are the larvae of mites that burro into
    your skin and cause intense itching and small reddish welts. The
    intense irritation and subsequent scratching may result in secondary
    infection.

-   **Ticks**: Several different species, plentiful and lyme disease
    (occurrences throughout the south) can be debilitating.

-   **Deer Flies & No-see-ums**: quite annoying and will keep you
    slapping.

**[Bees:]{.underline}**

-   **Bumble and Honey Bee**: Allergic reactions can be extremely
    serious. Remember to scrape the stinger out not pinch it with
    tweezers.

-   **Wasp, Hornet, Yellow Jacket**: Of these, be most concerned with
    hornets nests. If disturbed, they will swarm with potentially
    hundreds of attacks. Likewise, Yellow Jackets swarm; they nest in
    the ground and may already be disturbed by the heavy rains. Yellow
    jackets love gator-aid, soda and juice.

+-----------------------------------------------------------------------+
| ## Hurricane Dis                                                      |
| aster in the U.S.: Interim Health Recommendations for Relief Workers  |
|                                                                       |
| **Released:** September 2, 2005                                       |
|                                                                       |
| On August 29, 2005 a category 4-5 hurricane (Katrina) struck coastal  |
| areas of the states of Alabama, Florida, Louisiana, and Mississippi,  |
| causing numerous deaths, massive infrastructure damage, and flooding. |
| Along the Gulf Coast of Louisiana and Mississippi, the two hardest    |
| hit areas, hundreds of people remain missing. In addition, because of |
| massive flooding, a large-scale evacuation effort is underway to      |
| relocate the population of several parishes of Louisiana.             |
|                                                                       |
| Because of their potential exposures relief workers are at increased  |
| risk for developing illness and injuries. In addition, they should be |
| aware of potential hazards such as, downed power lines and security   |
| measures that may be imposed such as, curfews to prevent looting.     |
| Those who provide assistance should also pay attention to their       |
| mental health needs before, during, and after their time in the       |
| field. Moreover, because relief workers' services are desperately     |
| needed, it is essential that workers remain healthy during their      |
| trip. This notice provides additional advice specific to the needs of |
| relief workers.                                                       |
|                                                                       |
| Relief workers should plan for travel with the knowledge that there   |
| may be shortages of electricity, safe water, or food distribution     |
| systems in areas affected by the hurricane. They should try to pack   |
| to be as self-sufficient as possible and bring only those items       |
| necessary for their trip. In addition to a basic [travel health       |
| kit](http://www.cdc.gov/travel/other/travelers-health-kit.htm),       |
| relief workers should bring the following items:                      |
|                                                                       |
| Toiletries                                                            |
|                                                                       |
| -   Alcohol-based hand sanitizer                                      |
|                                                                       |
| -   Toilet paper                                                      |
|                                                                       |
| -   Sunblock (spf 15 or higher)                                       |
|                                                                       |
| -   Insect repellent containing DEET                                  |
|                                                                       |
| -   Menstrual supplies                                                |
|                                                                       |
| -   Extra pair of prescription glasses, copy of prescription          |
|                                                                       |
| -   Eyeglasses repair kit                                             |
|                                                                       |
| -   Contact lenses, lens cleaner, and eye glasses protective case     |
|                                                                       |
| -   Toothbrush/toothpaste                                             |
|                                                                       |
| -   Skin moisturizer                                                  |
|                                                                       |
| -   Soap, shampoo                                                     |
|                                                                       |
| -   Lip balm                                                          |
|                                                                       |
| -   Razor, extra blades\*                                             |
|                                                                       |
| -   Scissors\*                                                        |
|                                                                       |
| -   Nail clippers/tweezers\*                                          |
|                                                                       |
| -   Q-tips, cotton swabs                                              |
|                                                                       |
| Clothing                                                              |
|                                                                       |
| -   Comfortable, light weight clothing                                |
|                                                                       |
| -   Long pants                                                        |
|                                                                       |
| -   Long sleeved shirts                                               |
|                                                                       |
| -   Hat                                                               |
|                                                                       |
| -   Boots                                                             |
|                                                                       |
| -   Shower shoes                                                      |
|                                                                       |
| -   Rain gear                                                         |
|                                                                       |
| -   Bandana/handkerchief                                              |
|                                                                       |
| -   Towel (highly absorbent, travel towels if possible)               |
|                                                                       |
| -   Gloves\                                                           |
|     Leather gloves if physical labor will be performed; rubber gloves |
|     if handling blood or body fluids                                  |
|                                                                       |
| Activities of daily living                                            |
|                                                                       |
| -   Sunglasses                                                        |
|                                                                       |
| -   Safety goggles                                                    |
|                                                                       |
| -   Water proof watch                                                 |
|                                                                       |
| -   Flashlight                                                        |
|                                                                       |
| -   Spare batteries                                                   |
|                                                                       |
| -   Knife, such as a Swiss Army Knife or Leatherman\*                 |
|                                                                       |
| Security                                                              |
|                                                                       |
| -   Money belt                                                        |
|                                                                       |
| -   Cash                                                              |
|                                                                       |
| -   Cell phone (with charger)                                         |
|                                                                       |
| -   Candles, matches, lighter in a ziplock bag                        |
|                                                                       |
| -   Ziplock bags                                                      |
|                                                                       |
| -   An item of comfort (i.e., family photo, spiritual or religious    |
|     material)                                                         |
|                                                                       |
| \*packed in checked baggage, may be confiscated if in carry-on on     |
| commercial airliner                                                   |
|                                                                       |
| **Risk and Health Reccomendations**                                   |
|                                                                       |
| The response to the recent hurricane will probably be both immediate  |
| and long term. Relief workers should ideally be assessed by a         |
| health-care professional at least 4-6 weeks before travel so          |
| recommended vaccines can be completed and provide maximum benefit.    |
| These recommendations apply even if travel is imminent. All relief    |
| workers with a history of incomplete or lapsed routine, "childhood"   |
| immunization schedules should be brought up-to-date for these         |
| vaccines.                                                             |
|                                                                       |
| -   **Tetanus/diphtheria (Td)** Tetanus and diphtheria toxoid         |
|     (receipt of primary series, and Td booster within 10 years).      |
|                                                                       |
| > Persons with high likelihood of exposure to blood and body fluids   |
| > such as healthcare workers:                                         |
|                                                                       |
| -   **Hepatitis B** vaccine series for persons who will be performing |
|     direct patient care or otherwise expected to have contact with    |
|     bodily fluids.                                                    |
|                                                                       |
| **Risks from Injury**                                                 |
|                                                                       |
| The risk for injury during and after a natural disaster is high.      |
| Persons who anticipate the need to travel in hurricane-affected areas |
| should be advised to wear sturdy footwear to protect their feet from  |
| widespread debris present in these areas.                             |
| [Tetanus](http:/                                                      |
| /www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=dtp.htm) |
| is a potential health threat for persons who sustain wound injuries.  |
| Any wound or rash has the potential for becoming infected and such    |
| wounds or rashes should be assessed by a health-care provider as soon |
| as possible. Any wounds, cuts, or animal bites should be immediately  |
| cleansed with soap and clean water. Familiarity with basic first aid  |
| is advised to self-treat any injury until medical attention can be    |
| obtained.                                                             |
|                                                                       |
| **Preventing Electrocutions**                                         |
|                                                                       |
| Relief workers should be careful to avoid downed power lines. During  |
| power outages, many people use portable electrical generators         |
| (<http://www.bt.cdc.gov/poweroutage/workersafety.asp>). If the        |
| portable generator is improperly sized, installed, or operated, it    |
| can send power back to the electrical lines. This problem is called   |
| backfeed or feedback in the electrical energy in power lines.         |
| Backfeed can seriously injure or kill repair workers or people in     |
| neighboring buildings. In addition, electrical power and natural gas  |
| or propane tanks should be shut off to avoid fire, electrocution, or  |
| explosions. Battery-powered flashlights and lanterns, rather than     |
| candles, gas lanterns, or torches, should be used.                    |
|                                                                       |
| **Risks from Food and Water **                                        |
|                                                                       |
| Natural disasters contribute to the spread of many serious food and   |
| water-borne diseases, especially since water supplies and sewage      |
| systems have been disrupted. Diarrheal diseases, due to bacteria,     |
| parasites or hepatitis A can possibly occur. If a trusted source of   |
| bottled water is not available, water should be boiled or             |
| disinfected. For more details, see                                    |
| <http://www.cdc.gov/travel/foodwater.htm>.                            |
|                                                                       |
| An antibiotic for self-treatment of acute diarrhea, such as a         |
| fluoroquinolone (e.g. ciprofloxacin), can be given. Azithromycin can  |
| be used as an alternative. This medication should be taken until      |
| symptoms subside (typically 3 days). Anti-motility agents such as     |
| loperamide and diphenoxylate and/or bismuth subsalicylate             |
| (Pepto-Bismol) can reduce bowel movement frequency.                   |
|                                                                       |
| Seek medical attention for diarrhea accompanied by a high fever or    |
| blood. Additionally, replacement of lost fluids by drinking clean     |
| water is the most important means of maintaining wellness, although   |
| oral rehydration solutions are ideal for the treatment of severe      |
| diarrhea.                                                             |
|                                                                       |
| Cleaning your hands often, using soap and water (or waterless         |
| alcohol-based hand rubs when soap is not available and hands are not  |
| visibly soiled), removes potentially infectious material from your    |
| skin and helps prevent disease transmission.                          |
|                                                                       |
| **Risks from Insect Bites **                                          |
|                                                                       |
| Because of standing water in these areas, mosquito breeding can       |
| become a problem. The first mosquitoes to appear and the majority     |
| will be a nuisance and likely not transmit disease. The potential     |
| exists for outbreaks of [West                                         |
| Nile](http://www.cdc.gov/ncidod/dvbid/westnile/index.htm), [St.Louis  |
| Encephalitis](http://www.cdc.gov/ncidod/dvbid/arbor/slefact.htm), and |
| [dengue](http://www.cdc.gov/ncidod/dvbid/dengue/index.htm ); however  |
| this has not been typical of similar events in the U.S. Prevention of |
| mosquito bites is recommended through combined use of insect          |
| repellent containing DEET or picardin                                 |
| (<http://www.cdc.gov/ncidod/dvbid/westnile/mosquitorepellent.htm>),   |
| and wearing long sleeved shirts and long pants when outdoors.         |
|                                                                       |
| **Risks from Snake Bites **                                           |
|                                                                       |
| Displaced reptiles, such as snakes, are likely to be found following  |
| flooding and other natural disasters. The venom of a small or         |
| immature snake can be even more concentrated than that of larger      |
| ones; therefore, all snakes should be left alone. Fewer than half of  |
| all snakebite wounds actually contain venom, however, medical         |
| attention should be immediately sought any time a bite wound breaks   |
| the skin.                                                             |
|                                                                       |
| If medical care is rapidly available,then initial treatment should    |
| include immobilization of the affected limb and minimizing physical   |
| activity as much as possible (ideally of the entire patient) while    |
| transport to a medical facility occurs. If care is delayed, then a    |
| loose fitting pressure bandage that does not restrict arterial and    |
| venous flow (but does limit lymphatic flow) is the recommended        |
| first-aid measure while the victim is moved as quickly as possible to |
| a medical facility. Tourniquets that impair blood flow to the         |
| affected limb are generally contraindicated.                          |
|                                                                       |
| Specific therapy for snakebites is controversial, and should be left  |
| to the judgment of local emergency medical personnel. Snakes tend to  |
| be active at night and in warm weather. As a precaution, boots and    |
| long pants should be worn when walking outdoors at night in areas     |
| possibly inhabited by venomous snakes. Proper protection such as the  |
| aforementioned clothing, careful attention to one\'s surroundings and |
| overall avoidance of contact are the best measures that can be taken  |
| to avoid injury.                                                      |
|                                                                       |
| **Other Health Risks **                                               |
|                                                                       |
| [Leptospiro                                                           |
| sis](http://www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_g.htm ) |
| may occur in individuals who wade, swim, or bathe in waters           |
| contaminated by animal urine. In addition, exposure to animal bites,  |
| most notably bats or skunks in the South Central U.S, pose a          |
| potential risk for [rabies](http://www.cdc.gov/ncidod/dvrd/rabies/)   |
| and other infections. Individuals who sustain a bit should seek       |
| immediate medical attention for both appropriate management of the    |
| bite wound and assessment regarding post-exposure propyhylaxis.       |
|                                                                       |
| During natural disasters, technological malfunctions may release      |
| hazardous materials (e.g., release of toxic chemicals from a point    |
| source displaced by winds or rapidly moving water). Natural disasters |
| may also lead to air pollution. Lung infections may occur after       |
| inhalation of sea water. Disasters resulting in massive structural    |
| collapse can cause the release of chemical or biologic contaminants   |
| (e.g., asbestos or arthrospores leading to fungal infections).        |
| Persons with chronic pulmonary disease may be more susceptible to     |
| adverse effects from these exposures.                                 |
|                                                                       |
| There are health risks related to extremely hot temperatures such as  |
| found in these areas (heatstroke) and the effects of the sun on the   |
| eyes (cataracts) and skin (skin cancer, sunburn), see                 |
| <http://www.cdc.gov/chooseyourcover/SunDay-brochure.htm>. Wraparound  |
| sunglasses that provide 100 percent UV ray protection should be worn  |
| for eye protection. A broad-spectrum (protection against both UVA and |
| UVB rays) sunscreen and lip screen with at least SPF 15 should be     |
| used. Become familiar with the signs of illness related to extreme    |
| heat and what to do, see                                              |
| <http://www.bt.cdc.gov/disasters/extremeheat/heat_guide.asp#def>.     |
|                                                                       |
| **Psychological/Emotional **                                          |
|                                                                       |
| Because of the tremendous loss of life, serious injuries, missing and |
| separated families, and destruction of whole areas, it is important   |
| that relief workers recognize the situation they encounter may be     |
| extremely stressful. Keeping an item of comfort, such as a family     |
| photo, favorite music, or religious material nearby can often offer   |
| comfort in such situations. Checking in with family members and close |
| friends from time-to-time is another means of support. For additional |
| mental health resources, see                                          |
| <http://www.bt.cdc.gov/masstra/copingpub.asp>.                        |
|                                                                       |
| On return from one of the affected areas, relief workers who are      |
| unwell or who have become injured for any reason should receive a     |
| medical evaluation. This should include psychological support and     |
| counseling as necessary. Returning relief workers should seek health  |
| care in the event of fever, rash, respiratory illness or any other    |
| unusual symptoms.                                                     |
|                                                                       |
| Additional information about hurricane Katrina relief efforts can be  |
| found at the Federal Emergency Management Agency (FEMA) website,      |
| <http://www.fema.gov/> and CDC Emergency Preparedness and Response    |
| website, <http://www.bt.cdc.gov/>.                                    |
+-----------------------------------------------------------------------+
|                                                                       |
+-----------------------------------------------------------------------+
| **Date:** September 2, 2005                                           |
+-----------------------------------------------------------------------+
| **Content Source:** National Center for Infectious Diseases, Division |
| of Global Migration and Quarantine                                    |
+-----------------------------------------------------------------------+

## Self-Care Tips for Emergency and Disaster Response Workers

### 

###### Normal Reactions to a Disaster Event

-   No one who responds to a mass casualty event is untouched by it

-   Profound sadness, grief, and anger are normal reactions to an
    abnormal event

-   You may not want to leave the scene until the work is finished

-   You will likely try to override stress and fatigue with dedication
    and commitment

-   You may deny the need for rest and recovery time

###### Signs That You May Need Stress Management Assistance

-   Difficulty communicating thoughts

-   Difficulty remembering instructions

-   Difficulty maintaining balance

-   Uncharacteristically argumentative

-   Difficulty making decisions

-   Limited attention span

-   Unnecessary risk-taking

-   Tremors/headaches/nausea

-   Tunnel vision/muffled hearing

-   Colds or flu-like symptoms.

-   Disorientation or confusion

-   Difficulty concentrating

-   Loss of objectivity

-   Easily frustrated

-   Unable to engage in problem-solving

-   Unable to let down when off duty

-   Refusal to follow orders

-   Refusal to leave the scene

-   Increased use of drugs/alcohol

-   Unusual clumsiness

> **Ways to Help Manage Your Stress**

-   Limit on-duty work hours to no more than 12 hours per day

-   Make work rotations from high stress to lower stress functions

-   Make work rotations from the scene to routine assignments, as
    practicable

-   Use counseling assistance programs available through your agency

-   Drink plenty of water and eat healthy snacks like fresh fruit and
    whole grain breads and other energy foods at the scene

-   Take frequent, brief breaks from the scene as practicable.

-   Talk about your emotions to process have seen and done

-   Stay in touch with your family and friends

-   Participate in memorials, rituals, and use of symbols as a way to
    express feelings

Pair up with a responder so that you may monitor one another\'s stress.