Read almost any emergency checklist and pay attention to the person it was apparently written for.
That person can carry cases of water up the stairs, walk several miles without help, sleep on a gym floor, eat whatever food is handed to him and go several days without medication. He can hear emergency instructions, understand them immediately, load his own vehicle and evacuate without arguing, panicking or becoming confused. If the power goes out, he grabs a flashlight. If the building needs to be evacuated, he walks down the stairs.
That person probably exists somewhere. He just does not represent most American households.
Real households include elderly parents, young children, people taking several medications, diabetics using insulin, adults with limited mobility, people on oxygen concentrators, children with feeding pumps, family members with dementia and people who cannot tolerate a crowded public shelter. They also include exhausted caregivers who may be the only person in the house who knows how the medical equipment works.
The standard preparedness checklist barely acknowledges any of this.
Ready.gov recommends one gallon of water per person per day, shelf-stable food, a flashlight, a hand-crank radio, batteries, a whistle, dust masks and a wrench for shutting off utilities. Those are reasonable supplies, but they assume every member of the household is physically capable of using them and can survive without much else.
On the same website, the federal government acknowledges that about half the country takes a prescription medication every day and warns that disasters can make it difficult to reach a pharmacy or refill a prescription. Despite that, its printable emergency checklist places prescription drugs and eyeglasses under “additional items to consider,” alongside sleeping bags, disposable plates and other optional supplies.
The medicine that keeps someone from having a seizure is optional. The whistle makes the basic list.
That contradiction should tell you everything you need to know about who these plans are designed for.
Half the Country Depends on Prescription Medication
According to the CDC, nearly half of Americans have taken at least one prescription drug during the previous 30 days. Roughly one-quarter take three or more medications, and more than 13 percent take five or more. Among adults over 60, prescription use is closer to 85 percent.
That means the average American household is more likely than not to contain someone who depends on a pharmacy.
Not every prescription becomes an immediate emergency when it runs out. Missing several days of a cholesterol medication may not cause any noticeable problem. Other drugs are a different story. Abruptly stopping certain blood-pressure medications can cause dangerous rebound symptoms. Missing anticonvulsants can trigger seizures in someone who has been stable for years. A person who depends on insulin may be dealing with a life-threatening emergency in hours, particularly if no medical care is available.
The problem is that preparedness advice tends to lump all of these medications into one category called “meds,” as though every prescription bottle carries the same level of importance. It does not. Some prescriptions improve long-term health. Others are keeping a person alive today.
Your family’s medication plan has to start by identifying which drugs can be missed briefly, which drugs should never be stopped suddenly and which drugs create an immediate emergency if the supply is interrupted. That is a conversation to have with the prescribing doctor or pharmacist before a hurricane, wildfire or blackout shuts down half the city.
Building a reserve is also more difficult than many people assume. Insurance companies commonly reject refills until most of the previous prescription should have been used. Controlled substances are even more restricted, and Schedule II medications cannot legally be refilled under federal law. Each fill requires a new prescription.
Many people assume emergency rules will allow them to walk into a pharmacy and receive an extra month. In most states, that is not guaranteed.
Healthcare Ready reviewed emergency prescription laws throughout the country and found that only a limited number of jurisdictions had laws or regulations specifically covering emergency refills during a declared public health emergency. Even then, many of those rules only take effect after the governor declares an emergency. Florida has a stronger hurricane law that can suspend refill-too-soon restrictions and require insurers to cover a 30-day emergency supply. Many other states offer little more than a phone number and the hope that somebody will make an exception.
The time to build a medication buffer is before anything happens. Ask whether your insurance plan allows 90-day prescriptions. Ask the doctor whether an additional supply is medically and legally appropriate. If the prescription is inexpensive and noncontrolled, ask whether you can purchase an extra month with cash. Some insurers also allow vacation overrides, although the rules vary.
Any additional medication needs to be stored properly and rotated. Throwing an extra bottle into a hot garage for three years is not a medical preparedness plan.
Millions of Americans Need Electricity to Stay Alive at Home
The federal government tracks electricity-dependent Medicare beneficiaries through the HHS emPOWER program. The program covers approximately 4.5 million at-risk Medicare beneficiaries, including around three million people who rely on electricity-dependent medical equipment to live at home.
That equipment includes ventilators, oxygen concentrators, BiPAP machines, feeding pumps, infusion pumps, suction equipment, electric wheelchairs, hospital beds, dialysis machines and cardiac-assist devices.
Those numbers only cover people found through Medicare claims. They do not include every child using a feeding pump, every younger adult receiving insurance through an employer or every medically fragile person covered by a private plan. The real number of Americans depending on a functioning electrical outlet is considerably higher.
When the grid goes down, the problem is not inconvenience. The wall outlet has become part of the person’s life-support system.
Texas learned this during the February 2021 winter storm. The state’s official mortality report included deaths caused by medical-equipment failure and lack of home oxygen. The state attributed 210 deaths to the disaster, while broader estimates of direct and indirect deaths were far higher.
One emergency call documented during the storm involved a person whose oxygen concentrator stopped when the power failed. A backup oxygen tank was available, but the caller did not know how to use it.
The equipment was sitting in the house. The plan still failed because nobody knew how to make the switch.
That is a problem throughout preparedness. People buy a backup device, place it in a closet and consider the job finished. Nobody opens the box, connects the regulator, reads the instructions or practices using it. During the emergency, they discover the backup requires tools, adapters, charged batteries or knowledge they do not have.
Owning medical equipment and being capable of using it are two completely different things.
Do the Battery Math Before the Blackout
Portable power stations are now marketed as an easy answer for home blackouts. Many are useful, but the advertising tends to show phones, camping lights and small refrigerators. Medical equipment can require far more power than people expect.
A common stationary oxygen concentrator such as the Philips Respironics EverFlo can draw around 350 watts while operating at five liters per minute. Larger ten-liter machines may require 500 to 600 watts. Portable pulse-dose concentrators use less electricity, but they are not a direct replacement for every continuous-flow machine.
A person prescribed continuous oxygen cannot simply switch to a small camping-friendly machine because the battery lasts longer. The backup has to provide the therapy the patient was actually prescribed.
A 350-watt concentrator running continuously uses approximately 8.4 kilowatt-hours every 24 hours. Once inverter losses and other inefficiencies are included, a power station advertised as having 1,000 watt-hours of capacity may only keep that machine operating for a couple of hours.
Not all night. Not until morning. A couple of hours.
Keeping the same concentrator operating through an eight-hour night may require several kilowatt-hours of usable battery capacity. Running it for a full day may require 10 to 12 kilowatt-hours or more, depending on the system and actual power draw. That is no longer a small portable battery sitting on a shelf. It is a much larger and more expensive backup-power system.
Do not size medical backup power by looking at product photos or guessing from the number printed on the side of the battery. Buy an inexpensive plug-in watt meter and measure the actual equipment. Test it at the prescribed settings and record its normal running draw, startup draw and total energy use over several hours.
Some devices offer ways to reduce power consumption without stopping essential treatment. A CPAP machine may use far less electricity when the heated humidifier and heated hose are disabled. Those features provide comfort, but the core airway therapy may continue without them.
That does not mean changing settings or removing medical functions without guidance. It means finding out which parts of the device are medically necessary and which parts can be shut down during a prolonged outage to conserve power.
The correct time to learn that is while the grid is still working.
A Generator Creates Its Own Set of Dangers
Whenever backup power comes up, someone says, “Just buy a generator.”
A generator can be an important part of an emergency plan, but it is not a box you drag out during a blackout and operate without preparation. It requires fuel, oil, maintenance, extension cords, a safe outdoor location and somebody physically capable of starting and managing it.
It can also kill everyone in the house.
The Consumer Product Safety Commission estimates that portable gasoline generators cause approximately 85 carbon-monoxide deaths each year. Most occur at homes, and weather-related power outages are the most common reason the generators were being used.
A portable generator can produce an enormous amount of carbon monoxide. Running one in a garage, near a door, beneath an open window or under a covered patio can allow the gas to enter the house. Carbon monoxide is colorless and odorless, and the first obvious symptoms may be headaches, confusion, nausea, weakness or vomiting. Those symptoms are easy to mistake for stress, exhaustion or illness during a disaster.
The 2021 Texas freeze caused one of the worst mass carbon-monoxide poisoning events in recent American history. More than 1,400 people reportedly received hospital treatment, and at least 17 died. Many families were trying to stay warm after the power failed.
After Hurricane Beryl knocked out power in Texas in July 2024, hundreds more people went to emergency rooms with carbon-monoxide poisoning. Some died. People used generators, grills and other fuel-burning equipment incorrectly because they were hot, desperate, exhausted and trying to help their families.
That is exactly why generator safety cannot depend on remembering the manual at two in the morning.
Keep the generator at least 20 feet from doors, windows and vents, with the exhaust pointed away from the building. Never run it inside a garage, even with the garage door open. Install battery-powered carbon-monoxide alarms near sleeping areas and test them regularly.
Store the required cords, adapters, oil and tools with the generator. Start it several times a year. Make sure more than one person knows how to operate it. Calculate how much fuel it uses under the expected load and decide how that fuel will be stored safely.
A generator can solve a power problem while creating a poisoning, fire or fuel-storage problem. Treat it as serious machinery, not an oversized flashlight.
Refrigerated Medication Is Not All the Same
Insulin creates a lot of fear during blackouts, but the actual storage guidance is more forgiving than many people realize.
The FDA states that many insulin products in vials or cartridges can remain unrefrigerated at temperatures between 59 and 86 degrees Fahrenheit for up to 28 days. That means a short outage in a reasonably cool home does not automatically destroy the insulin.
The greater threat is extreme heat. A refrigerator that loses power inside a 100-degree apartment is a different situation from one sitting inside a 72-degree home. During an emergency, the FDA advises keeping insulin as cool as possible without freezing it. Insulin that freezes should not be used.
Do not place insulin directly against ice or frozen packs. A person trying to protect it from heat can destroy it by freezing it instead.
It is also important not to apply the insulin rule to every refrigerated medication. Biologic drugs, injectable medications, liquid antibiotics and other products may have completely different temperature limits. Some tolerate room temperature for days or weeks. Others do not.
Call the pharmacist and ask about every temperature-sensitive medication in the house. Write the storage range, the allowable time outside refrigeration and the signs of damage on the household medical sheet. Include the exact product name, because different versions of similar medications may have different rules.
During a blackout, you should not be standing in a dark kitchen trying to search for a package insert while somebody is waiting for a dose.
A Backup That Depends on the Sick Person Is Not a Backup
In October 2019, PG&E shut off electricity in parts of Northern California as a wildfire-prevention measure. Robert Mardis Sr., a 67-year-old man with COPD and congestive heart failure, was staying with his daughter because she had prepared for the outage. She had a generator and additional oxygen available.
When the electricity was shut off at approximately 3:30 in the morning, the generator did not take over. Mardis was asleep using a CPAP machine. His family said he could not reach the backup oxygen tank in time. First responders found him on the floor and were unable to revive him.
The county coroner later ruled that severe coronary artery disease caused the death and did not attribute it directly to the power shutoff. His daughter believed the loss of power played a role.
Whatever conclusion someone reaches about the official cause of death, the preparedness lesson remains the same. The family had done far more than most households. They had moved him to a prepared home, purchased a generator and staged backup oxygen.
The plan still required a sleeping, medically fragile man to wake up in a dark room, understand what had happened, get out of bed, reach the oxygen tank and correctly connect it while struggling to breathe.
That is not redundancy. It is a chain of assumptions.
Any backup plan that requires the most vulnerable person in the household to perform a complicated task under stress needs to be redesigned. Backup oxygen should be within reach and ready to use whenever medically appropriate. The required regulator, tubing, wrench and instructions should be stored together. Another household member should be responsible for the changeover.
That person needs to practice the process. Turn off the lights and simulate the outage. Find out whether the tubing reaches the bed, whether the regulator is easy to read and whether the tank can be opened by the person expected to do it.
A plan that works only in daylight, while everyone is awake and calm, is not ready for an emergency.
The Caregiver May Be the Weakest Link in the Entire System
Approximately 63 million Americans provide unpaid care for a family member or friend. Many handle medication schedules, injections, wound care, feeding equipment and other medical tasks. Yet only a fraction receive formal training.
In many homes, one person knows everything.
She knows which pill gets cut in half, how much insulin to give, how to reset the feeding pump and where the oxygen wrench is kept. She knows which symptoms are normal, which symptoms require a call to the doctor and which ones mean calling 911 immediately.
Everyone else in the house assumes she will be there.
During an emergency, she may be injured, sick, trapped at work, stuck on the other side of a flooded road or physically unable to continue. The entire household medical plan can collapse because one exhausted person was the only one who knew how anything worked.
This is a classic single point of failure, but most families never identify it.
During a California power shutoff, one woman had a generator but could not start it because her husband, who had always handled the equipment, had recently died. The machine was present. The capability had died with him.
Every important medical and emergency task needs a written procedure. Keep the instructions simple enough that someone unfamiliar with the equipment can follow them. Write down how to start the generator, connect the backup oxygen, silence an alarm, prime a pump and contact the equipment provider.
Tape a copy near the device and place another in the emergency binder. Do not rely entirely on a phone, because the battery may be dead and the internet may be unavailable.
At least one other person should be trained to handle every critical task. A reliable neighbor who lives two houses away may be more useful than an adult child who lives an hour across town. Ideally, you have both.
The person receiving care should also understand as much of the procedure as he or she is capable of learning. The goal is not to replace the caregiver. It is to make sure the entire system does not fail when one person is unavailable.
Some People Will Not Understand or Cooperate With Evacuation
Emergency planners often describe evacuation as a transportation problem. Put the family in the car, take the planned route and drive to the shelter.
That description ignores what happens when someone refuses to leave, cannot understand what is happening or becomes overwhelmed when the routine suddenly changes.
More than seven million Americans are living with Alzheimer’s disease. Millions more have other cognitive disabilities that make concentrating, remembering or making decisions difficult. Families may also include autistic children or adults, people with serious mental illness and anyone whose stability depends on medication that is now difficult to obtain.
For these households, an evacuation order can trigger a second emergency inside the first one.
A person with dementia may not understand why strangers are entering the home or why everyone is rushing toward the door. He may insist that the house is safe, refuse to get into the car or try to wander back home from a shelter. A person with autism may be unable to tolerate sirens, flashing lights, crowds, unfamiliar food or the constant noise inside a public shelter.
Telling the family to “just evacuate” does not solve any of this.
Identification needs to remain attached to the person rather than sitting inside a wallet or bag that can be lost. Use an identification bracelet or place a card inside a jacket pocket with the person’s name, condition and at least two phone numbers. Keep a current photograph on your phone and in the emergency binder in case the person wanders away.
Pack the familiar items that help control anxiety and behavior. That may include headphones, a blanket, a specific snack, a familiar cup, comfort items or a tablet containing downloaded entertainment. These supplies may look unimportant next to food and water, but they can determine whether the person remains calm enough to evacuate safely.
Try to preserve routines whenever possible. Use the same caregiver, the same explanations and the same objects. A crowded gym filled with fluorescent lights, strangers and constant noise may be unbearable, so identify quieter shelter options before the emergency.
Preparedness is not only about keeping someone physically alive. It is also about preventing predictable behavior and sensory problems from turning the evacuation into a dangerous struggle.
Mobility Changes Everything
More than 12 percent of American adults report serious difficulty walking or climbing stairs.
When the electricity fails in a multistory building, elevators stop working. A person using a cane may be able to descend slowly with assistance. Someone in a heavy power wheelchair may have no realistic way to leave.
A 300-pound chair cannot simply be carried down five flights of stairs. Neither can every adult with severe arthritis, heart disease or respiratory problems.
During California power shutoffs, testimony described an 81-year-old woman living in a second-floor apartment who needed nebulizer treatments twice each day. With the elevator out, caregivers and volunteers physically carried her down the stairs, drove her somewhere with power for the treatment and then carried her back upstairs. They repeated the process twice a day.
That is not a reasonable household backup plan. It is an emergency improvisation that happened to work because enough people were available to perform heavy physical labor.
Anyone with limited mobility needs to know exactly how evacuation would work from every floor of the home or building. Identify who can assist, which equipment is required and whether emergency personnel can reach the location. Ask the building manager what happens when the elevator fails. Do not accept vague answers about calling the fire department.
Firefighters and paramedics may already be overwhelmed during a widespread emergency.
Wheelchairs, walkers, canes, transfer boards, portable ramps, extra batteries and repair tools should be included in the plan. Label the equipment with contact information. Keep manual backup options available when possible, especially if the person normally depends on a powered chair.
Transportation also matters. A standard rideshare vehicle may not accommodate a large wheelchair. Paratransit systems may stop operating or become overwhelmed. The household needs more than one transportation option and should know how far in advance specialized transportation must be requested.
“Just leave” is not a plan when the person cannot get down the stairs or fit inside the car.
Dialysis Patients Cannot Simply Wait for Things to Improve
People receiving in-center dialysis normally attend treatment several times each week. Missing one session may create serious problems. Missing several can become life-threatening.
After Hurricane Katrina, researchers studied dialysis patients from New Orleans-area clinics. Nearly half missed at least one treatment, and a significant number missed three or more. Patients who missed several treatments faced a much higher risk of hospitalization.
Two of the strongest predictors of missed treatment were living alone and not knowing the dialysis facility’s emergency plan.
That is important because it can be addressed without buying any gear.
Call the clinic and ask for its disaster plan in writing. Find out which backup facility will receive patients if the regular center closes. Ask how patients will be contacted, whether an early dialysis session can be scheduled before a forecast storm and what dietary or fluid restrictions should be followed if treatment is delayed.
Write down the name, address and phone number of the backup clinic. Identify transportation options to both facilities. Keep the information in the emergency kit and give a copy to an out-of-area family member.
Do not assume the clinic will call at the last minute. Phone lines may fail, staff may be evacuating their own families and the number on file may no longer be current.
The same rule applies to chemotherapy, infusion treatments and other scheduled medical care. Ask what happens when the facility closes. Make the provider give you an actual answer before the emergency.
Build a Household Medical Plan That Reflects Reality
Start with a one-page medical sheet for every member of the household. List all diagnoses, medications, doses, schedules, allergies, medical devices, equipment settings, doctors, pharmacies and insurance information. Include the storage requirements for refrigerated medications and the model numbers of important equipment.
Print several copies. Keep one in the emergency kit, one with the person and one with an out-of-area contact. Update the sheet whenever a medication or device changes.
Build a realistic medication buffer rather than fantasizing about a ten-year stockpile. Work within prescription laws, insurance rules and safe storage limits. Rotate the supply so the oldest medication is used first.
Measure the real electrical draw of every medical device. Do not rely only on the label or the salesperson. Determine how many hours the battery can actually operate the equipment and test the entire setup under load.
Register with the utility’s medical-baseline, life-support or critical-care program if one is available. These programs may provide advance notice of planned outages or other benefits, but do not mistake registration for guaranteed power restoration. A phone call from the utility does not keep an oxygen concentrator running.
Keep backup oxygen where it can be reached and practice the changeover. Install carbon-monoxide alarms if a generator will ever operate on the property. Store generator instructions, fuel, cords and tools together.
Assign at least two people to every critical task. Make sure both have actually performed the procedure. Watching someone start the generator once is not the same as being able to start it alone in the dark.
Identify the household members who cannot walk out, cannot understand an evacuation order or cannot tolerate a public shelter. Build the plan around their actual limitations instead of assuming they will somehow become stronger, calmer or more cooperative when disaster strikes.
Most of this work does not require expensive survival equipment. It requires phone calls, paperwork, testing and practice.
That is why so few people do it.
Stop Preparing for a Household You Do Not Have
The preparedness industry loves the image of the lone, physically fit man heading into the woods with a rifle, a knife and 40 pounds of equipment strapped to his back. He is easy to market to because every problem can be solved with another piece of gear.
That is not what most emergencies look like.
A real emergency may involve an older woman whose CPAP battery is running out, a father with COPD sleeping in a spare bedroom, a child who cannot tolerate the noise of a public shelter or an elderly dialysis patient whose clinic has closed. The person responsible for everyone may be exhausted, injured or trapped across town.
Those families can buy every item on the official checklist and still discover that the plan was written for somebody else.
Millions of Americans depend on electrically powered medical equipment. Tens of millions depend on daily medication. Millions cannot walk down a stairwell or understand why they are being evacuated. More than 60 million Americans are providing care to someone else, often with little formal training and no backup.
This is not a rare special-needs category. It is ordinary American life.
Texas documented people dying because medical equipment failed and home oxygen became unavailable during an outage. Families have owned generators they could not start and backup tanks they did not know how to connect. People have been poisoned because they brought fuel-burning equipment too close to the house while trying to keep their children warm.
The standard checklist did not prevent any of it because the checklist was never enough.
Write the medical sheets. Measure the wattage. Test the batteries. Move the oxygen tank close enough to reach. Call the pharmacy, dialysis clinic, equipment supplier and utility before something goes wrong. Teach another person how to operate every device keeping someone alive.
Then shut off the lights one evening and run the plan.
You will probably find something that does not work. A cord will be too short, the backup battery will be dead, the regulator will be missing or the person expected to start the generator will not know where the fuel valve is.
Finding that problem tonight is an inconvenience. Finding it during an outage can kill somebody.
Prepare for the people who actually live in your house, not the imaginary healthy man the checklist was written for.
