Washington Post

Reuters

“…..At least 237 others have died and 1,900 were injured……”

FDA Offers Tips about Medical Devices and Hurricane Disasters

General Safety

• Keep your device and supplies clean and dry.
• If you depend on your device to keep you alive, seek emergency services immediately. If possible, notify your local Public Health Authority to request evacuation prior to adverse weather events.
• Always use battery powered flashlights or lanterns rather than gas lights or torches when oxygen is in use (to minimize the risk of fire).
• If your device appears to be damaged, or if you need a back-up device, contact your distributor or device manufacturer.
• Check all power cords and batteries to make sure they are not wet or damaged by water. If electrical circuits and electrical equipment have gotten wet, turn off the power at the main breaker.
• Maintain your device only in a well lit area so you can assess your device’s performance (e.g., refilling your insulin pump, checking your glucose meter).
• Keep your device in as clean and secure location as possible: off the ground, away from animals or crowded areas.
• Always check your device for pests before you use it (e.g., syringes, mechanical devices).

Power Outage

• Notify your electric company and fire department to let them know you have a medical device that needs power (e.g., ventilator, apnea monitor).
• Read your user instructions or call your distributor or device manufacturer to find out if your device can be used with batteries or a generator.
• Locate a generator if possible.
• Make sure you check for water before plugging in your device. Do not plug in a power cord if the cord or the device is wet.
• When the power is restored, check to make sure the settings on your medical device have not changed (often medical devices reset to a default mode when power is interrupted).

Water Contamination

Some medical devices and equipment, such as dialyzers or IV pumps, require safe water in their use, cleaning, and maintenance.

Hurricanes, especially if accompanied by a tidal surge or flooding, can contaminate the public water supply. In the area hit by a hurricane, water treatment plants may not be operating; even if they are, storm damage and flooding can contaminate water lines.

Listen to and follow public announcements about the safety of the municipal water supply.

In an emergency situation, follow these steps to ensure that your water is safe for use with your medical device:

• Use only bottled, boiled, or treated water until your supply is tested and found safe.
• If you use bottled water, be sure it came from a safe source. If you do not know that the water came from a safe source, you should boil or treat it before you use it.
• Boiling water, when practical, is the preferred way to kill harmful bacteria and parasites. Bringing water to a rolling boil for 1 minute will kill most organisms.
• When boiling water is not practical, you can treat water with chlorine tablets, iodine tablets, or unscented household chlorine bleach (5.25% sodium hypochlorite). If you use chlorine tablets or iodine tablets, follow the directions that come with the packaging.
• If you use household chlorine bleach, add 1/8 teaspoon (~0.75 mL) of bleach per gallon of water if the water is clear. For cloudy water, add 1/4 teaspoon (~1.50 mL) of bleach per gallon. Mix the solution thoroughly and let it stand for about 30 minutes before using it.

Note: Treating water with chlorine tablets, iodine tablets, or liquid bleach will not kill parasitic organisms.

Use a bleach solution to rinse water containers before reusing them. Use water storage tanks and other types of containers with caution. For example, fire truck storage tanks and previously used cans or bottles may be contaminated with microbes or chemicals.

For additional information on keeping water safe, see http://www.bt.cdc.gov/disasters/foodwater.asp.

Sterility

• When performing medical procedures, maintain a clean environment by using bleach, alcohol, or a disinfectant in the area you are working (e.g., catheter changes, dressing changes, suctioning).
• Check sterile packaging to make sure it is dry and intact (e.g., sterile gauze). If the packaging is wet or damaged, do not use the product inside.
• When you purchase supplies, always check the packaging to make sure it hasn’t been damaged.

Re-use of Medical Devices

Do not reuse a medical device intended for single use.

If you find that you need additional single use products, contact a healthcare provider or emergency response personnel.

• If you need to reuse a device that is intended for multiple uses (e.g., infusion tubing, syringes), the device must be cleaned and disinfected or sterilized according to the device manufacturer’s instructions. Devices should not be boiled unless explicitly allowed on the product label or instructions for use.
• If you have supplies that are intended for multiple use with your medical device, follow the appropriate procedures for cleaning and disinfecting.
• If you need sterile water for cleaning, disinfecting, or sterilizing your device or its components, follow the above procedures for ensuring that your water is safe.

Dealing with Heat and Humidity

Heat and humidity can have an effect on home diagnostic test kits (including blood glucose tests used by people with diabetes). Test results may not be accurate. Read your owner’s manual to make sure your test kit is performing properly.

To protect your device from heat and humidity, follow the steps below:

• Use a dry cloth to wipe off your device regularly (e.g., mechanical infusion pumps).
• Keep your device out of direct sunlight.
• Enclose your medical products in plastic containers to keep them dry (e.g., wound care supplies).
• Do not use ice if there is a danger of water contamination; use dry ice or instant cold packs to keep your device cool (e.g., prefilled syringes).
• Do not use disposable devices that are wet (e.g., wound dressings, disposable thermometers, tubing).

RISK

“……The Resilience in Survivors of Katrina Project (“RISK”) Project (Mary Waters, PI, Jean Rhodes and Beth Fussell, co-PI’s)  is a longitudinal study of low-income parents who lived in New Orleans at the time of Hurricane Katrina. Starting in 2003—before the hurricane occurred—1,019 low-income parents from New Orleans enrolled in a study designed to increase educational attainment among community college students. The study measured participants’ economic status, social ties, and mental and physical health prior to the hurricane. Although Hurricane Katrina disrupted the study in August of 2005, it provided an extremely rare opportunity to study the consequences of a disaster for the lives of vulnerable individuals and their families. We have conducted two follow-up surveys and two rounds of in-depth qualitative interviews…..”

Washington Post

CNN

‘….”As of 2:30 a.m. we count 10,059 refugees and 189 pets (in shelters),” a tweet from the island’s governor, Ricardo Rosselló says….’

ZCZC MIATCPAT5 ALL
TTAA00 KNHC DDHHMM

BULLETIN
Hurricane Maria Advisory Number 17
NWS National Hurricane Center Miami FL AL152017
500 AM AST Wed Sep 20 2017

…CORE OF EXTREMELY DANGEROUS HURRICANE MARIA NEARING PUERTO
RICO…

SUMMARY OF 500 AM AST…0900 UTC…INFORMATION
———————————————-
LOCATION…17.9N 65.6W
ABOUT 15 MI…25 KM SSW OF VIEQUES
ABOUT 50 MI…75 KM SE OF SAN JUAN PUERTO RICO
MAXIMUM SUSTAINED WINDS…155 MPH…250 KM/H
PRESENT MOVEMENT…NW OR 305 DEGREES AT 10 MPH…17 KM/H
MINIMUM CENTRAL PRESSURE…917 MB…27.08 INCHES

WATCHES AND WARNINGS
——————–
CHANGES WITH THIS ADVISORY:

The government of France has discontinued the Tropical Storm
Warning for Guadeloupe.

The government of the Bahamas has issued a Hurricane Warning for
the Turks and Caicos Islands and the Southeastern Bahamas.

The government of the Netherlands has discontinued the Hurricane
Watch for Saba and St. Eustatius.

SUMMARY OF WATCHES AND WARNINGS IN EFFECT:

A Hurricane Warning is in effect for…
* U.S. Virgin Islands
* British Virgin Islands
* Puerto Rico, Culebra, and Vieques
* Dominican Republic from Cabo Engano to Puerto Plata
* Turks and Caicos Islands and the Southeastern Bahamas

A Tropical Storm Warning is in effect for…
* Saba
* St. Maarten
* Dominican Republic west of Puerto Plata to the northern border of
the Dominican Republic and Haiti
* Dominican Republic west of Cabo Engano to Punta Palenque

A Hurricane Watch is in effect for…
* St. Maarten
* St. Martin and St. Barthelemy
* Dominican Republic from Isla Saona to Cabo Engano

DISCUSSION AND 48-HOUR OUTLOOK
——————————
At 500 AM AST (0900 UTC), the center of Hurricane Maria was located
near latitude 17.9 North, longitude 65.6 West. Maria is moving
toward the northwest near 10 mph (17 km/h). A west-northwest
to northwest motion is expected to continue through today, followed
by a northwestward motion on Thursday. On the forecast track the
eye of Maria will make landfall in Puerto Rico in a couple of hours,
cross Puerto Rico today, and pass just north of the northeast coast
of the Dominican Republic tonight and Thursday.

Maximum sustained winds are near 155 mph (250 km/h) with higher
gusts. Maria is an extremely dangerous category 4 hurricane on the
Saffir-Simpson Hurricane Wind Scale, and it should maintain this
intensity until landfall.

Hurricane-force winds extend outward up to 60 miles (95 km) from the
center and tropical-storm-force winds extend outward up to 150 miles
(240 km). Fajardo recently reported sustained winds of 79 mph (128
km/h) with a gust to 100 mph (161 km/h).

The minimum central pressure recently reported by an Air Force
Hurricane Hunter aircraft is 917 mb (27.08 inches).

HAZARDS AFFECTING LAND
———————-
WIND: Tropical storm and hurricane conditions are occurring over
the Virgin Islands and are spreading over Puerto Rico. Hurricane
conditions are expected within the Hurricane Warning area in the
Dominican Republic tonight, with tropical storm conditions expected
by later today. Tropical storm conditions are expected in the
Tropical Storm Warning areas in the Dominican Republic later
today. Hurricane conditions are expected within the Hurricane
Warning area by late Thursday in the Turks and Caicos Islands and
the southeastern Bahamas, with tropical storm conditions in this
area by early Thursday.

Wind speeds atop and on the windward sides of hills and mountains
and on high-rise buildings could be much stronger than the near-
surface winds indicated in this advisory.

STORM SURGE: A dangerous storm surge accompanied by large and
destructive waves will raise water levels by as much as 4 to 6 feet
above normal tide levels in the hurricane warning area in the
Dominican Republic, and 1 to 3 ft elsewhere along the northern
coasts of the Dominican Republic and Haiti.

A dangerous storm surge accompanied by large and destructive waves
will raise water levels by as much as 10 to 15 feet above normal
tide levels in the Hurricane Warning area near and to the north of
the center of Maria for both the Southeastern Bahamas and the Turks
and Caicos Islands.

The combination of a dangerous storm surge and the tide will cause
normally dry areas near the coast to be flooded by rising waters
moving inland from the shoreline. The water is expected to reach
the following heights above ground if the peak surge occurs at the
time of high tide…

Puerto Rico and the U.S. Virgin Islands…6 to 9 ft

The deepest water will occur along the immediate coast near and to
the north and east of the landfall location, where the surge will be
accompanied by large and destructive waves. Surge-related
flooding depends on the relative timing of the surge and the tidal
cycle, and can vary greatly over short distances. For information
specific to your area, please see products issued by your local
National Weather Service forecast office.

RAINFALL: Maria is expected to produce the following rain
accumulations through Friday:

Central Leeward Islands…additional 1 to 2 inches.
Northern Leeward Islands from Barbuda to Anguilla…additional 2 to
5 inches.
U.S. and British Virgin Islands…additional 8 to 12 inches,
isolated 16 inches.
Puerto Rico…12 to 18 inches, isolated 25 inches.
Northern and eastern Dominican Republic and Turks and Caicos…4 to
8 inches, isolated 12 inches.
Northern Haiti and southeastern Bahamas…2 to 4 inches.

Rainfall on these islands will cause life-threatening flash floods
and mudslides.

TORNADOES: Several tornadoes are possible over Puerto Rico and the
U.S. Virgin Islands today.

THE EYE: Do not venture outside when the calm eye of the hurricane
passes over, as dangerous winds will return very quickly when the
eye moves away.

SURF: Swells generated by Maria are affecting the Leeward Islands,
Puerto Rico, and the Virgin Islands. These swells will begin
affecting the northern coast of Hispaniola, the Turks and Caicos
Islands, and the Southeastern Bahamas during the next day or two.
These swells are likely to cause life-threatening surf and rip
current conditions. Please consult products from your local weather
office.

NEXT ADVISORY
————-
Next intermediate advisory at 800 AM AST.
Next complete advisory at 1100 AM AST.

$$
Forecaster Pasch

CNN

“…..22 bodies were found in the debris of an elementary school in Mexico City that collapsed due to the earthquake. At least 30 children were still missing Tuesday night……”

ZCZC MIATCPAT5 ALL
TTAA00 KNHC DDHHMM

BULLETIN
Hurricane Maria Advisory Number 16
NWS National Hurricane Center Miami FL AL152017
1100 PM AST Tue Sep 19 2017

…EYE OF POTENTIALLY CATASTROPHIC CATEGORY 5 HURRICANE MARIA
NEARING ST. CROIX…
…CORE EXPECTED TO REACH SOUTHEASTERN PUERTO RICO WEDNESDAY
MORNING…

SUMMARY OF 1100 PM AST…0300 UTC…INFORMATION
———————————————–
LOCATION…17.3N 64.7W
ABOUT 30 MI…45 KM SSE OF ST. CROIX
ABOUT 120 MI…190 KM SE OF SAN JUAN PUERTO RICO
MAXIMUM SUSTAINED WINDS…175 MPH…280 KM/H
PRESENT MOVEMENT…WNW OR 300 DEGREES AT 10 MPH…17 KM/H
MINIMUM CENTRAL PRESSURE…909 MB…26.85 INCHES

WATCHES AND WARNINGS
——————–
CHANGES WITH THIS ADVISORY:

None

SUMMARY OF WATCHES AND WARNINGS IN EFFECT:

A Hurricane Warning is in effect for…
* U.S. Virgin Islands
* British Virgin Islands
* Puerto Rico, Culebra, and Vieques
* Dominican Republic from Cabo Engano to Puerto Plata

A Tropical Storm Warning is in effect for…
* Saba and St. Eustatius
* St. Maarten
* Guadeloupe
* Dominican Republic west of Puerto Plata to the northern border of
the Dominican Republic and Haiti
* Dominican Republic west of Cabo Engano to Punta Palenque

A Hurricane Watch is in effect for…
* Saba and St. Eustatius
* St. Maarten
* St. Martin and St. Barthelemy
* Dominican Republic from Isla Saona to Cabo Engano
* Turks and Caicos Islands and the Southeastern Bahamas

A Hurricane Warning means that hurricane conditions are expected
somewhere within the warning area. Preparations to protect life and
property should be rushed to completion.

A Tropical Storm Warning means that tropical storm conditions are
expected somewhere within the warning area.

A Hurricane Watch means that hurricane conditions are possible
within the watch area. A watch is typically issued 48 hours before
the anticipated first occurrence of tropical-storm-force winds,
conditions that make outside preparations difficult or dangerous.

Interests elsewhere in Hispaniola and the Bahamas should monitor the
progress of Maria.

For storm information specific to your area in the United
States, including possible inland watches and warnings, please
monitor products issued by your local National Weather Service
forecast office. For storm information specific to your area
outside the United States, please monitor products issued by your
national meteorological service.

DISCUSSION AND 48-HOUR OUTLOOK
——————————
At 1100 PM AST (0300 UTC), the center of Hurricane Maria was located
near latitude 17.3 North, longitude 64.7 West. Maria is moving
toward the west-northwest near 10 mph (17 km/h). A west-northwest
to northwest motion is expected to continue through Wednesday
night, followed by a northwestward motion on Thursday. On the
forecast track, the eye of Maria will move near or over St. Croix
in the U.S. Virgin Islands within the next couple of hours, then
cross Puerto Rico on Wednesday, and pass just north of the
northeast coast of the Dominican Republic Wednesday night and
Thursday.

Maximum sustained winds are near 175 mph (280 km/h) with higher
gusts. Maria is a potentially catastrophic category 5 hurricane on
the Saffir-Simpson Hurricane Wind Scale. Some fluctuations in
intensity could occur before the hurricane reaches Puerto Rico, but
Maria is forecast to remain an extremely dangerous category 4 or 5
hurricane as it moves near or over the Virgin Islands and Puerto
Rico. Slow weakening is expected after the hurricane emerges over
the Atlantic north of Puerto Rico and the Dominican Republic.

Reports from reconnaissance aircraft indicate that the area of
hurricane-force winds has increased in size. Hurricane-force winds
now extend outward up to 60 miles (95 km) from the center and
tropical-storm-force winds extend outward up to 150 miles (240 km).

The estimated minimum central pressure is 909 mb (26.85 inches).

HAZARDS AFFECTING LAND
———————-
WIND: Tropical storm conditions will continue in portions of the
warning area in the Leeward Islands tonight. Tropical storm
and hurricane conditions are occurring over the Virgin Islands and
will spread over Puerto Rico overnight. Hurricane conditions are
expected within the hurricane warning area in the Dominican Republic
late Wednesday, with tropical storm conditions expected by early
Wednesday. Tropical storm conditions are expected in the tropical
storm warning areas in the Dominican Republic on Wednesday.
Hurricane and tropical storm conditions are possible on Thursday in
the Turks and Caicos Islands and the southeastern Bahamas.

Wind speeds atop and on the windward sides of hills and mountains
and on high-rise buildings could be much stronger than the near-
surface winds indicated in this advisory.

STORM SURGE: A dangerous storm surge accompanied by large and
destructive waves will raise water levels by as much as 7 to 11
feet above normal tide levels in the hurricane warning area near
where the center of Maria moves across the Leeward Islands and the
British Virgin Islands.

A dangerous storm surge accompanied by large and destructive waves
will raise water levels by as much as 4 to 6 feet above normal tide
levels in the hurricane warning area in the Dominican Republic, and
1 to 3 ft elsewhere along the northern coasts of the Dominican
Republic and Haiti.

The combination of a dangerous storm surge and the tide will cause
normally dry areas near the coast to be flooded by rising waters
moving inland from the shoreline. The water is expected to reach
the following heights above ground if the peak surge occurs at the
time of high tide…

Puerto Rico and the U.S. Virgin Islands…6 to 9 ft

The deepest water will occur along the immediate coast near and to
the north and east of the landfall location, where the surge will be
accompanied by large and destructive waves. Surge-related
flooding depends on the relative timing of the surge and the tidal
cycle, and can vary greatly over short distances. For information
specific to your area, please see products issued by your local
National Weather Service forecast office.

RAINFALL: Maria is expected to produce the following rain
accumulations through Friday:

Central and southern Leeward Islands…additional 1 to 3 inches.
Northern Leeward Islands from Barbuda to Anguilla…additional 3 to
6 inches.
U.S. and British Virgin Islands…additional 8 to 12 inches,
isolated 16 inches.
Puerto Rico…12 to 18 inches, isolated 25 inches.
Eastern Dominican Republic…4 to 8 inches, isolated 12 inches.

Rainfall on all of these islands will cause life-threatening flash
floods and mudslides.

TORNADOES: Several tornadoes are possible over Puerto Rico and the
U. S. Virgin Islands tonight and Wednesday.

SURF: Swells generated by Maria are affecting the Leeward Islands,
Puerto Rico, and the Virgin Islands. These swells will begin
affecting the northern coast of Hispaniola, the Turks and Caicos
Islands, and the Southeastern Bahamas during the next day or two.
These swells are likely to cause life-threatening surf and rip
current conditions. Please consult products from your local weather
office.

NEXT ADVISORY
————-
Next intermediate advisory at 200 AM AST.
Next complete advisory at 500 AM AST.

$$
Forecaster Brown