Name: \t\t\t\t\tDate:\t\t\t\tRevise Date:<\/p>\n
One of the most important steps you can take in preparing for emergencies is to develop a household disaster plan. This involves creating a plan that identifies who you can contact in an emergency, what each member of your family must do, and how you can better prepare yourself for the situation. See Appendix A in your text. (Veenema, 2009)<\/p>\n
Assignment Instructions:
\nComplete the Family Disaster Plan Checklist<\/p>\n
1.\tComplete all sections. Use yes, no, check marks or x’s for items you do have. Use need, for items you do not have at this time. Use N\/A, for items not applicable for your living situation. Do not leave anything blank.
\n2.\tRemember to protect personal information by using pseudonyms, or by providing only partial information
\no\tEx: Sister: Britley *****, phone: 724-***-****, email: b********@yahoo.com
\n3.\tUse complete information for utility and public companies.
\n4.\tReview the rubric for more information on how the assignment will be graded.
\n5.\tPlease note: You are not required to purchase any items on this list, however, take note of the items you are missing and consider how it could impact your safety and survival in a disaster.
\n6.\tComplete the \u201cMy Family\u2019s Disaster Plan\u201d. Include your reference and in text citations.<\/p>\n
My Family\u2019s Disaster Plan
\nResearch potential disasters that could occur in your community. Select 2 (two) potential disasters and using about 25 words, examine how these potential disasters can impact you as a nurse. Provide at least 1 reference for each potential disaster. Use APA Style for your reference(s) and in text citation(s).
\nPossible hazards in my area # 1
\nReference<\/p>\n
Possible hazards in my area # 2
\nReference<\/p>\n
____________________________________________________________________________<\/p>\n
Emergency Phone Numbers – (Program these into all phones and post in a common area in the home.)
\nAddress\tPhone #
\nPolice Department
\nFire Department
\nLocal Emergency Services
\nLocal American Red Cross
\nPoison Help\t\t1-800-222-1212
\nHealthcare Providers
\n\u25cf\tDoctor
\n\u25cf\tDentist
\n\u25cf\tOther (add additional important personal contacts)<\/p>\n
Employers and School Officials Contacts
\nI know the emergency response plans for employers and schools. _____<\/p>\n
For yourself, spouse, and significant other:
\nEmployer\/School\tAddress\tPhone #\tFacility Contact Name<\/p>\n
For children:
\nChild\u2019s Name\tChild Day Care\/Child School\tAddress\tPhone #\tFacility Contact Name<\/p>\n
Family Communication Plan
\nPrepare a family communication plan so that each member of the family can contact one another quickly. (Put 10 most important numbers on a card in your wallet.)
\n\u25cf\tEveryone has a cell phone or calling card _____
\n\u25cf\tYoung children know how to call (numbers are saved) ______<\/p>\n
Name\tContact Name\tPhone\tEmail<\/p>\n
Identify two meeting places for your family in the event that you are separated.
\nLocation near your home:
\nLocation\tAddress\tPhone\tEmail<\/p>\n
Location away from your home (in the event you cannot return home):
\nLocation\tAddress\tPhone\tEmail<\/p>\n
Pick at least 1 or 2 friends or relatives who live out of the area for household members to call\/email to say they are okay. (If you want, add others as backup.)
\nName\tPhone\tEmail\tAddress<\/p>\n
Draw a floor plan of your home. Mark two escape route pathways from each room to each exit. You may use this space to draw your floor plan or imbed a photo. You may attach your drawing page to the end of this document ~OR~ Attach as a 2nd document to your assignment submission (Do not submit the document as a 2nd submission attempt. It will negate your 1st submission attempt. Submit as an additional document in 1 attempt. If you still have questions on how to submit this assignment, please ask before submitting.)
\n______<\/p>\n
Everyone in the house knows how, when and where to shut off utilities. ______<\/p>\n
Utility Name\tPhone Number\tShut-Off Location\/Main Controls at your residence
\nElectric
\nWater
\nGas<\/p>\n
Evacuation Plan and Transportation
\nExtra gallon of gas ______
\nIf you do not have a car, make plans with a neighbor or your local government agency to be evacuated.
\nNeighbor\/Local Government Agency\tPhone Number\tAddress<\/p>\n
_____________________________________________________________________________<\/p>\n
Property, Health, and Financial Well-being
\nReview property insurance policies for disaster policies. ______
\nCurrent ______\t\t\tAppropriate to needs ______
\nReview life-insurance policies. ______
\nCurrent ______\t\t\tAppropriate to needs ______
\nReview health insurance policies. ______
\nCurrent ______\t\t\tAppropriate to needs ______
\nReview financial documents. ______
\nEmergency savings $______\t\tEasily accessible, small cash savings $ ______<\/p>\n
Important Documents and Items Secured
\nMake sure you have copies of important documents and items that can be stored in a fireproof watertight container.
\nImportant Items\tCheck off photocopied items that are safely stored
\nPersonal identification
\nCash and coins
\nCredit card(s)
\nExtra set of house keys and car keys
\nBirth certificate
\nMarriage certificate
\nDriver\u2019s license
\nSocial Security card
\nPassport\/visa
\nWills
\nDeeds
\nInventory of household goods (with photos & serial numbers)
\nInsurance papers
\nImmunization records
\n\u2014\tAllergies
\n\u2014\tMedications
\nBank and credit card numbers
\nStock\/bonds
\nEmergency contact list (phone\/address\/email)
\nLocal map and emergency shelter locations
\nPet information
\nAdditional:<\/p>\n
______________________________________________________________________________<\/p>\n
Pet Arrangements
\nAs per local and state health and safety regulations, pets are not permitted in some shelters such as American Red Cross shelters. Service animals are permitted.<\/p>\n
Name of Veterinarian and Name of Local Animal Shelter:
\nName of Veterinarian\tAddress\tPhone\tEmail<\/p>\n
Name of Local Animal Shelter\tAddress\tPhone\tEmail<\/p>\n
Names of pet friendly hotels\/motels or friends\/family out of the area:
\nName\tAddress\tPhone\tEmail<\/p>\n
______________________________________________________________________________<\/p>\n
Special Needs Helpance
\nSpecial needs Helpance organization in community.
\nName\tAddress\tPhone\tEmail<\/p>\n
Register with your local office of emergency services or fire department.
\nName\tAddress\tPhone\tEmail<\/p>\n
Consider ways to help neighbors who may need special Helpance (ESL\/medical\/living alone).
\nName\tSpecial Help Needed\tAddress\tPhone<\/p>\n
Create a network of neighbors, friends, relatives, coworkers to aid you in an emergency
\n\u25cf\tMobility escape chair in place _____
\n\u25cf\tHigh-rise\/apartment arrangements for emergency evacuation _____
\n\u25cf\tExtra wheelchair batteries, oxygen, catheters, medications, food for service animals _____
\n\u25cf\tCaregiver identification information _____
\n\u25cf\tMedical bracelet, etc. _____
\n_____________________________________________________________________________<\/p>\n
Certifications
\nStay current and up to date (e.g., CPR, ACLS, PALS, TNCC).
\nCertification \tDate of Completion\tDate of Renewal<\/p>\n
_____________________________________________________________________________<\/p>\n
Disaster Supply Kit \u201cGo Bag\u201d
\nYou and your family may need to survive on your own for 3 days or more. Consider having additional supplies for up to two weeks confinement or shelter. You should prepare emergency supplies for the following situations:<\/p>\n
Go Bags
\nMake sure all family members know where the go bags are and have access to them.
\nHome go bag _____
\nPet go bag _____
\nChild go bag with special items for feeling safe and staying occupied _____
\nCar go bag – 3-day supplies included with emergency roadside equipment _____
\nWork go bag _____<\/p>\n
Water Supplies
\nStocking water supplies should be a top priority. Drinking water in emergency situations should not be rationed. It is critical to store adequate amounts of water for your household.<\/p>\n
Check off all of the basic items you have and list additional specialty items you have on hand:
\nWater
\nChange water every 6 months. \tOn Hand\tNeed to Acquire\tNext water change _____________ (date)
\nTwo quarts of water daily for drinking for each person in your household
\nOne gallon\/week supply of water stored for sanitary and cooking needs for your household.
\nAdditional Specialty Items:\tOn Hand\tNeed to Acquire\tNext water change _____________ (date)
\nExtra two quarts of water daily for children, nursing mothers, and those who are ill and need more.
\nSafety Tip: Water Storage and Collection in an Emergency
\n\u25cf\tDo not store in glass containers or other containers that can break.
\n\u25cf\tDo not rely on untested devices for decontaminating water.
\n\u25cf\tIf you have a well or public water, follow treatment methods provided by your public health service or water provider.
\n\u25cf\tStore water in a cool, dark place.
\nFood: Preparing and Emergency Supply
\nFood, unlike water may be rationed except for children and pregnant women. No special food needed. Keep canned foods and dry mixes stocked. Replenish food supplies every 6 months. Use and replace. Store newer items in the back, older items in front.<\/p>\n
Check off all of the basic items you have and list additional specialty items you have on hand:
\nHigh energy protein foods\tOn Hand\tNeed to Acquire
\nPeanut butter
\nTrail mix
\nGranola bars
\nPeanuts
\nHard candy
\nBoxed juices
\nPowdered milk
\nDry fruits
\nAdditional Specialty Items:\tOn Hand\tNeed to Acquire<\/p>\n
Add items you need for your family situation:
\nInfant foods\tOn Hand\tNeed to Acquire<\/p>\n
Specialty diet foods\tOn Hand\tNeed to Acquire<\/p>\n
First Aid Supplies
\nAssemble a first aid kit for your home. ______
\nAssemble a first aid kit for each vehicle. ______<\/p>\n
Check off all of the basic items you have and list additional specialty items you have on hand:
\nBasic First Aid Supplies\tOn Hand\tNeed to Acquire
\nFirst aid manual
\nSterile adhesive bandages, assorted sizes
\nSafety pins assorted sizes
\nCleansing agents
\nAntibiotic ointment
\nLatex gloves (2 pair)
\nPetroleum jelly or other lubricant
\n2-inch and 4-inch sterile gauze pads (4 to 6 of each)
\nTriangular bandages (3)
\nSunscreen
\nScissors
\n2-inch and 3-inch sterile roller bandages (3 rolls each)
\nTweezers
\nNeedle
\nMoistened towelettes
\nAntiseptic
\nThermometer
\nTongue depressor blades (2)
\nPrescription medication list (ask your pharmacist about storing prescription medications)
\nExtra pair or prescription eyeglasses or contacts
\nNonprescription drugs:\tOn Hand\tNeed to Acquire
\nAspirin and non\u2014aspirin pain relievers
\nAntidiarrheal medication
\nAntacid
\nLaxative
\nVitamins
\nSyrup of ipecac
\nAdditional Specialty Items:\tOn Hand\tNeed to Acquire<\/p>\n
Tools and Emergency Supplies
\nAssemble these items in a disaster supply kit in case you need to leave quickly.<\/p>\n
Check off all of the basic items you have and list additional specialty items you have on hand:
\nTools\tOn Hand\tNeed to Acquire
\nPortable, battery-powered radio, TV, alarm clock
\nFlashlight and extra batteries
\nSignal flare
\nMatches in a waterproof container
\nShut-off wrench, pliers, shovel, hammer, screwdriver, and other tools
\nDuct tape and scissors
\nPlastic sheeting
\nWhistle
\nA-B-C fire extinguisher
\nTube tent
\nCompass
\nWork gloves
\nPaper, pen, pencils
\nNeedles and thread
\nAdditional Specialty Items:\tOn Hand\tNeed to Acquire<\/p>\n
Check off all of the basic items you have and list additional specialty items you have on hand:
\nSanitation and Hygiene\tOn Hand\tNeed to Acquire
\nWashcloth and towel
\nTowelettes, soap, hand sanitizer, liquid detergent
\nToiletries
\nHeavy-duty plastic garbage bags
\nMedium–sized plastic bucket with tight lid and small shovel for digging a latrine.
\nDisinfectant and household chlorine bleach
\nAdditional Specialty Items:\tOn Hand\tNeed to Acquire<\/p>\n
Check off all of the basic items you have and list additional specialty items you have on hand:
\nKitchen Items\tOn Hand\tNeed to Acquire
\nManual can opener
\nMess kits or paper cups, plates, plastic utensils
\nAll-purpose knife
\nA dropper (eye dropper) with measurements
\nLiquid bleach to treat water
\n\u25cf\tOnly use regular, unscented chlorine bleach products that are suitable for disinfection and sanitization as indicated on the label. The label may say that the active ingredient contains 6 or 8.25% of sodium hypochlorite. Do not use scented, color safe, or bleaches with added cleaners. If water is cloudy, let it settle and filter it through a clean cloth, paper towel, or coffee filter.<\/p>\n
Sugar, salt, pepper
\nAluminum foil, plastic wrap
\nResealing plastic bags
\nAdditional Specialty Items:\tOn Hand\tNeed to Acquire
\nIf food must be cooked, a small camping stove and can of cooking fuel<\/p>\n
Check off all of the basic items you have and list additional specialty items you have on hand:
\nClothes and Bedding \tOn Hand\tNeed to Acquire
\nOne complete change of clothes and footwear for each member of the household. Shoes should be sturdy work shoes or boots.
\nRain gear, hats and gloves, extra socks and underwear, thermal underwear, sunglasses.
\nBlankets or sleeping bags and pillows for each member.
\nAdditional Specialty Items:\tOn Hand\tNeed to Acquire<\/p>\n
Check off all of the basic items you have and list additional specialty items you have on hand:
\nSpecialty Items as needed for Baby \tOn Hand\tNeed to Acquire<\/p>\n
Check off all of the basic items you have and list additional specialty items you have on hand:
\nSpecialty Items as needed for Elderly\tOn Hand\tNeed to Acquire<\/p>\n
Check off all of the basic items you have and list additional specialty items you have on hand:
\nSpecialty Items as needed for Pets\tOn Hand\tNeed to Acquire<\/p>\n
Other Items
\nReview other disaster preparedness websites for items not included here.<\/p>\n
Check off items that you have and list items you need to acquire.<\/p>\n
Item
\nIncluded<\/p>\n","protected":false},"excerpt":{"rendered":"
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