SEVEN

STAY SAFE: FIRST AID, HEALTH, AND SAFETY

Avoiding illness or injury will be one of the most critical parts of life following the Really Big One. Getting proper treatment will be difficult or impossible, and even a “minor” illness or injury can become a real problem without adequate care. Safe water and food, required medication, a stable routine, and adequate sleep are especially important to your health.

Preparing for the difficulties of not just acquiring adequate water, food, and shelter but doing so safely will be a huge priority. People will overwhelmingly want to live outside (as they did after earthquakes in Haiti in 2010 and Puerto Rico in 2019 to 2020). But outside will also be home to lots of flies, cats, dogs, rats and mice, and all sorts of other critters tracking bacteria from the exponentially greater-than-normal volumes of rotting food and exposed human and animal waste all over—particularly in denser urban areas.

Keeping hands, food, and food preparation and serving areas sanitary without running water will be difficult or impossible. As discussed in Chapter Four (this page), drinking only uncontaminated water will be important, but few people will have stored enough safe water to last until clean water is distributed. Food- and waterborne illness will be hard to avoid and especially dangerous, given constraints on treatment. Imagine the challenge of keeping everyone in your family from getting a stomach bug if patient zero doesn’t have access to a flush toilet or a post-vomit shower, and is going through all this just a few feet away from where food is stored and prepared without access to hot running water. It’s gross, but it’s also a likely scenario.

If you do get sick or hurt, help will no longer be easily accessible: few pharmacies, hospitals, or clinics stock more than a two-day supply of drugs, and demands on the system will skyrocket, while staff will be limited to whoever can get there or stay there. All of this means that, again, you’ll want to prepare using a “how can we be as self-sufficient as possible” mentality.

FIRST-AID KIT

You should have a good first-aid kit stored with your supplies at home and a smaller one in your go-bag. Most of the basic first-aid kit supplies (listed in the checklist at the end of this chapter) are pretty self-explanatory. But one thing might not be obvious: you’ll want a good first-aid manual. Step-by-step pictures of treatment are helpful. First-aid manuals for backcountry hikers focus on treatment in wilderness conditions, but are also helpful in the post-earthquake scenario because they don’t assume that a patient can be easily transported to a hospital or clinic.

Ideally, you will also be able to complete a first-aid class or Community Emergency Response Team (CERT) training as part of getting two-weeks-ready. But the world isn’t always ideal, yet even if you don’t have first-aid skills (or the wherewithal to acquire them), having a comprehensive first-aid kit means that you can contribute supplies to someone who does.

And first aid isn’t limited to physical wounds: the Red Cross and other organizations offer “emotional first-aid” classes that teach you how to help comfort a victim of trauma and assess if further care is needed. If you shudder at the sight of blood but are drawn to comforting those in distress, this skill might be for you.

MOST COMMON EARTHQUAKE INJURIES AND HEALTH RISKS

  • Cuts from broken glass

  • Head and body injuries from falling objects

  • Injuries from being thrown to the ground by the shaking

  • Burns

  • Strains and sprains

  • Shock

  • Heart attacks and strokes

  • Hypothermia in colder climates or seasons; heat exhaustion or heat stroke in hotter climates or seasons

  • Dehydration

BASIC HEALTH REQUIREMENTS

Many things help us stay healthy: clean air and water, fresh food, medicine, a predictable routine, uninterrupted sleep, sewer systems and garbage service to remove waste, health-care providers, a heated and/or air-conditioned home. Right after a mega-earthquake, most of these things will be gone. But other things that support health can emerge: a strong sense of purpose, closeness with others, work that produces immediate benefits.

Staying healthy will be easier for some than for others. Children, nursing and pregnant women, and medically vulnerable people are harder hit by dehydration and food shortages. Their needs should be prioritized over those of healthy adults.

CLEAN AIR

Dust from collapsed structures and smoke from fires will lessen air quality after a mega-earthquake. Wearing an N95 mask will protect you from breathing in harmful particles. However, after the massive fire in Paradise, California, in 2018, officials found that wearing masks in a smoke-filled environment for many hours or days made it harder for some people to get adequate oxygen, which can cause stress to the body, especially for people with preexisting health problems. So advice about using face masks has changed: there is no perfect recommendation that will eliminate all risk, but pay attention to air conditions and how you feel, and use a mask if necessary.

SAFE WATER AND FOOD

Drinking unsafe water or eating contaminated food can cause vomiting and diarrhea. In post-earthquake conditions, these can be life threatening, especially to vulnerable people. Find the safest sources of water that you can. Purify any untreated water by boiling, using purification tablets, or adding bleach per the directions in Chapter Four (this page). Don’t eat food that has been in your refrigerator or freezer past the times recommended for safety (see this page). Remember, most people can adapt to limited food. Being hungry is better than being sick.

MEDICATIONS

Having critical medications on hand could be lifesaving since pharmacies may not be open for some time. However, in most cases insurance won’t cover the cost of extra medication and you’ll have to pay the full retail price for an extra prescription to store in case of a disaster.

Talk to your doctor or pharmacist about medications you take, as some drugs can safely have dosages reduced for a time, while others cannot. You should know what the impact of a sudden withdrawal of your critical medications might be. Work with your doctor to address what your medication needs will be after the earthquake.

Some people stockpile medications or save expired medicine. If you choose this route, be sure you talk to a health professional to make sure the medication will be safe.

For more information on complex medical needs, see Chapter Ten (this page).

A HEALTHY ROUTINE

Establishing a stable routine may seem like a laughable endeavor post-earthquake, yet it is one of the most important things you can do to ensure health, especially if your household has children. Unless you follow a predictable routine, critical behaviors for health—drinking enough clean water, washing hands, getting enough rest—may diminish drastically in the intensity of post-earthquake living. Things that happen as a matter of habit today will need to happen because you build them into a routine after the earthquake.

There will be hundreds of things you can’t control after the earthquake: You won’t know when aftershocks are coming. You won’t know how dozens of people you care about have fared. You won’t know when help will reach you. These things you don’t know and can’t control may overwhelm you unless you establish things you can control. Those things make up your routine.

Having a stable routine supports mental and emotional health, not just physical well-being. Activities that have always helped humans survive harrowing circumstances—meditation and prayer, song, dance, stories, games, poetry, art, shared rituals—are an important part of any post-earthquake routine. When material comforts are gone, psychological, spiritual, and social comforts are even more critical.

SLEEP

A major threat after the earthquake will be making bad decisions that put you and your loved ones at risk. Research shows that lack of sleep and faulty thinking are firmly linked. Not getting enough sleep also reduces your body’s ability to fight off infection and illness, so it needs to be a part of your routine, and you need to plan for ways to make sure you can sleep as well as possible.

Use or improvise earplugs and sleep masks to avoid noise and light. Create a comfortable sleeping space. Use a hot-water bottle to warm where you are sleeping. Work to avoid insect bites or injuries that may disturb sleep.

Try to keep your household’s usual sleep times as normal as possible, especially for children. If you decide nearby fires or unstable structures may become a danger, take turns on a night-watch shift so that no one person becomes sleep deprived.

CLEANLINESS

Without running water, staying clean will be a chore. It may seem less important than the more urgent tasks you face. But with limited or no access to medical care, staying clean is essential: it helps prevent the spread of germs and stops small wounds from becoming infected.

Even though it might entail considerable inconvenience, wash hands after using whatever toilet system you’ve created, before and after meals, and before touching food or water supplies. Wash face, neck, groin, and armpits daily if possible. Comb or brush hair and brush teeth.

Use rainwater and other nonpotable water sources for hand washing clothes if it’s available. If not, turn clothes inside out, shake them hard, and air them in the sun to freshen them. Change underwear and socks as often as you can.

USING HAND SANITIZER

Hand sanitizer doesn’t clean dirty hands, so make sure to use wet wipes or water to remove obvious dirt before sanitizing. Then follow the steps below: a study on hand sanitizer use showed this method of washing was significantly more effective in eliminating bacteria than a single washing.

  1. Place a generous amount of hand sanitizer in your palm.

  2. Imitate how a television surgeon performs hand washing, getting into every crevice.

  3. Wipe dry with a paper towel.

  4. Use another large amount of sanitizer and repeat the process.

  5. Let the sanitizer air-dry.

SAFETY IN HAZARDOUS CONDITIONS

Staying safe after the earthquake will mean paying attention to risks that are different from the ones we’re used to. Living on ground that shakes frequently in aftershocks, for instance, will mean we can stay safe only if we are constantly aware of what could fall on us or where we could fall if we’re knocked down by a tremor.

Recognize that your brain won’t be working well after the earthquake and, like someone who has had far too much to drink, you may wrongly believe you have your wits about you, especially if you are also hungry, thirsty, and exhausted. Yet you’ll have high-stakes decisions to make, so discuss options with others and take as much time as you can for decision-making to minimize risk.

FIRE AND SMOKE

The capacity to fight fires will be limited after the earthquake, making them likely to spread. Fire will be a deadly post-earthquake danger. Smoke may make breathing difficult. Just as in a wildfire situation, you’ll need to be ready to evacuate to stay safe. Unlike a wildfire situation, however, experts won’t be able to provide critical information about fire location and actions to take.

At any minute you may need to evacuate by foot—you’ll want to be constantly ready to pick up and move immediately when you or someone nearby signals it’s time to go. It’s a good idea to have an agreed-on signal for people in your area to call on one another for help fighting a fire. Discuss fire safety with your family and emphasize the dangers of the coming aftershocks, and coordinate fire extinguisher placement with others nearby. While everyone placing fire extinguishers in front of their homes by the curb will work in single-family neighborhoods, a central agreed upon location can be established for apartment and condominium residents.

BASIC FIRE SAFETY

  • Without power, people often try to cook indoors with a barbecue grill using charcoal briquets or with a camp stove, which kills people every year because these methods create carbon monoxide, a colorless, odorless gas. Only cook outdoors when using barbecues or outdoor stoves!

  • Keep cooking flames, barbecues, and outdoor stoves away from anything that could catch fire. Expect aftershocks while using any source of fire.

  • Dig a pit to build a campfire in, lessening the risk of scattered coals or burning wood. (Be careful not to start a fire in tree roots!)

  • Keep a fire extinguisher close whenever you build a fire. At other times, put the fire extinguisher on the curb in front of your house for others to use to fight fires.

  • Use silicon or other heavy cooking mitts to handle hot pots and cooking tools. Remember, even small burns may be hard to treat.

  • Don’t use candles, lamp oil, or kerosene lanterns in the first weeks after an earthquake due to the risk of aftershocks.

  • Store all fuel away from flames.

  • Store rags that have been used to clean up flammable liquids away from anything that could catch fire, ideally in a metal container, as they can spontaneously burst into flames.

Even if no large fire threatens, people will be using small fires to cook and stay warm. Burns were a common and often serious injury in the days of open fires, woodstoves, and kerosene lanterns. After the earthquake, preventing burns will be vital because even minor burns will be hard to treat effectively—your present-day casualness around flame will be dangerous.

FALLING DEBRIS AND UNSTABLE SURROUNDINGS

What appears stable after the main earthquake may become dangerous due to additional damage from aftershocks, so staying safe from injuries will be a continual battle. The strongest aftershocks are usually earlier in the sequence of earthquakes set off by a major event, so balance how urgently you need something in a dangerous location with the risk of entering the area. And always be aware of what is above you—it might not stay there. Things falling from buildings and walls after earthquakes are a major source of head injuries.

You’ll want to wear a hard hat or a bicycle, motorcycle, or other type of helmet if you must go into an area that may be unsafe. Even a sturdy book opened above your head or a wastebasket used as improvised protection could help.

Be careful of catching falling or flying objects to avoid sprains to fingers or wrists. When cleaning up debris or making repairs, wear safety goggles, work gloves, and sturdy clothing and shoes. Pace yourself: heart attacks and strokes are common when people stressed from a disaster try to do things that are too much for them.

HOUSEHOLD HAZARDS

WEATHER

Colder and wetter weather—and, in the Pacific Northwest, these can occur in nearly every month—bring risk of hypothermia, especially if you have to live outdoors after a mega-earthquake. People can become hypothermic even in low 50-degree temperatures. Add a hat and neck scarf to help maintain body heat, and if you get chilled, use instant heat packs under your arms to recover as quickly as possible.

In very hot, dry conditions, heat exhaustion and heat stroke are hazards, especially if there’s a shortage of potable water. Stay hydrated and wear loose clothing to avoid getting overheated. If you feel too hot, seek shade and remove your hat and socks to cool down safely.

DARKNESS

After a mega-earthquake, your surroundings will be completely dark after nightfall—your home, streetlights, and other outdoor lighting will all be off if there is no electrical power. To carry out necessary tasks after dark, having enough light reduces the risk of accidents. Light also creates a feeling of safety and security that can support health. Children may find having a flashlight especially reassuring, so they have control over being able to see when unfamiliar noises disturb them at night. Finally, light at night also allows people to read, play games, or engage in other activities that ease stress.

Many people use their cell phones as a flashlight, but with power outages, you’ll want to preserve your phone charge. Battery-operated flashlights and lanterns with solar or hand-crank backup power are recommended. Solar garden lights are handy for marking the path to a latrine or bucket toilet. Candles of any kind, along with kerosene lanterns, should be avoided, as aftershocks make them highly hazardous.

UNENCLOSED SPACES

Pets and small children are easily contained within the walls of our homes and care facilities. After a mega-earthquake, you may be compelled to move outside, but you’ll need to keep children and pets safe without the ease of indoor walls. Improvised enclosures may work, but having appropriate pet crates, playpens, or play-yard fences will make life easier. Even friendly pets can become dangerous when stressed and hungry. Be cautious around your own pets and other animals you encounter.

STRAY ANIMALS AND WILDLIFE

  • Don’t leave food out in accessible containers—this attracts stray animals and wildlife.

  • Don’t look a stray dog in the eyes—this is a sign of aggression.

  • Don’t run away from a stray dog or wild animal—this may trigger an animal’s chasing instinct. Back away very slowly if you can do so without triggering increased growling or barking.

  • Don’t travel alone—travel with at least one other person. Two or more people are a less attractive target to aggressive strays or wildlife.

SOCIAL BREAKDOWN MYTHS

Many emergency-preparedness books predict a quick and savage unraveling of our social fabric following a disaster. This view is amplified in movies that depict widespread violence and chaos after a catastrophic event; even media coverage of disasters often seems to support this vision of hazardous conditions.

But fears and myths about what others will do don’t match what the research finds. Post-disaster studies are clear and consistent: people go to unusual, often heroic lengths to help each other in the immediate aftermath of natural disasters. Crime goes down, temporarily, and social connections tend to strengthen rather than unravel. Many people find their faith in humanity fully restored, rather than cruelly destroyed.

However, disasters can amplify existing tensions in a town or neighborhood, especially if corruption, unequal treatment, racial or religious divisions, or high rates of health issues or poverty become magnified by the situation. No one can guarantee what will happen after a Cascadia earthquake. If it is reassuring to you to prepare for the possibility of social breakdown, you can do so, but it is best to focus on preparing for the most likely threats, not the least likely ones.

MYTH ABOUT THE DECEASED

Another common myth is that the bodies of earthquake victims are somehow dangerous and may cause the spread of disease. The World Health Organization specifically states that only the bodies of those who have died of highly infectious diseases pose a risk to the greater community. Don’t allow fear of the deceased to result in hasty burials or mass graves. In disasters where this has happened, it has not protected the health of survivors, but it has greatly complicated the grief of those who weren’t able to choose what happened to the body of their loved one.

FIRST-AID AND HEALTH CHECKLIST

FIRST-AID KIT: NECESSARY

□ Comprehensive first-aid manual

□ Assorted sizes of adhesive bandages

□ Gauze pads—2-inch by 3-inch (off-the-shelf first-aid kits have assorted sizes, but cuts are the most common post-earthquake injury, so an additional box is a good idea)

□ Medical tape

□ Celox—for emergency blood clotting

□ Antiseptic pads

□ Antiseptic spray or liquid (isopropyl alcohol, hydrogen peroxide)

□ Antibiotic ointment

□ Moleskin—for blisters

□ Scissors

□ Tweezers and magnifying glass—for removing glass or wood splinters

□ Latex-free or nitrile gloves

□ Saline solution

□ Anti-diarrheal medication*

□ Pain and fever medication*

□ Anti-nausea medication*

□ Cold and flu medicine*

□ Calamine lotion—for bug bites, sunburn, poison ivy (or similar anti-itch medication)

□ Hydrocortisone cream—for rashes and minor skin irritation (or similar anti-itch medication)

□ Thermometer

□ Zinc oxide—for sunscreen, to prevent chafing, and to reduce oozing from poison ivy and similar irritants

□ Mylar emergency blanket(s)

*Purchase hard pills rather than liquid form whenever possible; these may keep their effectiveness and safety past the expiration date better than liquid forms of medication.

FIRST-AID KIT: NICE TO HAVE

□ Burn gel

□ Dental wax (reduces irritation from chipped tooth)

□ Tourniquet

□ Small splints

□ Elastic bandage(s)

□ Adhesive heat patches—for use with arthritis and strained muscles

□ Instant heat packs—for hands (use under arms for maximum benefit)

GENERAL HEALTH NEEDS: NECESSARY

□ Routine medications or substitutes

□ Substances habitually used that could result in withdrawal if not available (alcohol, nicotine, cannabis, etc.)

□ Required medical devices or supplies and power source (see Chapter Ten, this page)

□ Wet wipes

□ Soap

□ Hand sanitizer (at least 60 percent alcohol)

□ Comb, brush, shampoo

□ Toothbrush, toothpaste, dental floss

GENERAL HEALTH NEEDS: IF APPLICABLE

□ Feminine hygiene products

□ Contact lenses and solution

□ Eyeglasses with protective hard case

□ Hearing aids with extra batteries

GENERAL HEALTH NEEDS: NICE TO HAVE

□ Two-week supply of N95 masks (one per person per day)

□ Sunscreen

□ Insect repellent

□ Hot-water bottle

□ Quick-dry towels

□ Earplugs, sleep masks

□ Activity materials—books, arts and crafts supplies, portable CD player and CDs

□ Comfort items for children and adults—stuffed animals, family pictures, favorite blankets

SAFETY EQUIPMENT: NECESSARY

□ Fire extinguisher(s)

□ Hard hat or bicycle, motorcycle, or other helmet

□ Leather-palmed work gloves

□ Safety goggles

□ Hard-soled shoes

□ Heavy contractor-weight garbage bags

□ Pet carrier, crate, playpen, and/or yard enclosure—for containing pets and small children

□ Extra leash(es)—for securing pets in car and outdoor location as well as regular location in home

□ Flashlight(s) and/or lantern(s), plenty of spare batteries (solar and hand-crank-supplemented models are best)

SAFETY EQUIPMENT: NICE TO HAVE

□ High-heat-resistant cooking gloves

□ Fire suppression blanket

□ Extra-loud marine whistle(s)—for signaling danger, scaring animals

□ Dog-deterrent spray

□ Dog muzzle (allows dog to eat and drink but not bite)

□ Binoculars—for tracking fires

□ Solar garden lights