Chronic Illness and Disasters: Development of a Theoretical Framework

Incidence of both natural disasters and chronic illnesses has increased worldwide, and in the United States, over the past 10 to 20 years. (IEG World Bank, 2007; World Health Organization, 2009). Disasters have increasing numbers of victims, public health threats, and financial implications (Cherry & Trainer, 2008; Ginter et al., 2006). In 2005, 133 million Americans were diagnosed with at least one chronic illness (Centers for Disease Control and Prevention, 2012). During disasters, persons with chronic illnesses face risks above those of the general population including exposure to infectious disease, respiratory compromise, disrupted skin integrity (Cherry & Trainer, 2008), medication separation (Greenough et al., 2008; Howe, Victor, & Price, 2008), and loss of access to healthcare records (Pate, 2008; Smith & Macdonald, 2006). A disaster is considered a sudden or serious event that disrupts humans and the environment to the extent that overwhelms both individual and local resources and requires extraordinary effort to recover (Noji, 2000). Disaster response typically comprises five phases: non-disaster, pre-disaster, impact, emergency, and reconstruction, which may occur at individual, local, regional, and federal levels (Veenema, 2007). Preparedness activities taken during early stages improve response to a disaster regardless of the scope or type of event (Arrieta, Foreman, Crook, & Icenogle, 2008; Chan & Sondorp, 2007). Disaster preparedness is more complex for those with chronic illness, who may require specific planning to address unique needs (Jones, 2006a). A chronic disease (e.g., cardiovascular disease, renal failure, diabetes) persists at least three months or more and cannot be prevented by vaccines or cured with medication (U.S. National Center for Health Statistics, 2007). Exploring the simultaneous burden of disaster response and chronic disease can help responders better understand needs of specific populations and design collaborative efforts among responding agencies. The aim of this study was to describe how individuals with chronic illnesses who have experienced a disaster managed health-related challenges such as medication needs, food and water intake, and wound management during the disaster using disaster preparedness or response activities. Review of Literature There is strong evidence that those who have chronic illness(es) are particularly vulnerable to negative outcomes during a disaster (Arrieta et al., 2008; Mokdad, Mensah, Posner, Reed, Simoes, & Engelgau, 2005; Saunders, 2007; Zoraster, Vanholder, & Sever, 2007). These outcomes may be a result of illness (e.g., increased susceptibility to injury and/or infection) and the disaster itself (e.g., separation from medication or treatment, inhaled toxins or crush/blast injuries, contamination of food and water; Miller & Arquilla, 2008). Research studies have suggested that individuals with chronic illnesses will take actions to self-manage their disease (Gregg & Callaghan, 2007; Whittemore & Dixon, 2008). Preparedness activities (e.g., preparation for possible evacuation) taken during non- and pre-disaster stages improved response to a disaster regardless of the scope or type of event (Arrieta et al., 2008; Chan & Sondorp, 2007), suggesting the possibility that such activities by persons with chronic illness may well help them to manage their disease during the actual event. Response activities that include collaboration among resources and response at several or all levels, including needs-based assessments, and consensus-based protocols, was supported as the ideal structure for effective and timely disaster response in several articles (Chan & Sondorp, 2007; Howe et al., 2008; Jones, 2006b; Klein, Pepe, Burkle, Nagel, & Swienton, 2008; Kumagai, Edwards, & Carroll, 2006). Critical factors such resource accessibility and distribution remains an area with differing expectations about response effort at various levels and timeframe (Kumagai et al. …