During an Emergency

Shelter-in-Place

Shelter-in-place refers to remaining indoors as a precaution rather than seeking shelter elsewhere, such as at an emergency shelter. Local authorities may instruct you to shelter-in-place, evacuate and/or seek an emergency shelter through various means of communication (e.g. media, loud speaker, door-to-door, public alert system).

Knowing what is required to shelter-in-place while in different enclosures will help ensure you and your loved ones are safe when it is no longer safe to go outside. The following information provides the recommended steps to safely shelter-in-place while in your home or vehicle. However, you should also be aware of what steps your daycare(s)/school(s) and workplace(s) take when sheltering-in-place is required.

At Home

If you are advised by officials to shelter-in-place due to an emergency (e.g. chemical or radiological hazard) you should already have a pre-selected room in your home large enough to fit your entire family. This room may need to be sealed off using plastic sheeting and duct tape and should be above ground as some dangerous chemicals that are heavier than air can seep into the basement. When selecting the room, also consider that ten square feet of floor space per person is recommended to provide sufficient air and prevent carbon dioxide build-up for five hours. Preferably, this room will have few or no windows to reduce/prevent seepage of external contaminants and also have a hard-wired telephone as cellular telephone circuits may be overwhelmed or damaged during an emergency.

In general, if you are required to shelter-in-place at home, the following steps are recommended:

Bring your family, including pets, indoors immediately. If anyone is away at school or work do not try and bring them home unless told to do so; schools and workplaces will shelter them.
Close and lock all windows and exterior doors. If there is danger of an explosion, close all window coverings (e.g. shades, blinds, curtains).
Turn off heating, ventilation and/or air conditioning systems. Turn off all fans including bathroom and kitchen hood fans. Close any fireplace dampers.
Take everyone, including pets, into the pre-designated shelter-in-place room and close the door.
Take your emergency kit with you, including a working radio, so you can listen to broadcasts in order to know when it is safe to come out, or if you will need to evacuate.
If you have been instructed to seal the room, do so using duct tape and plastic sheeting. All points of entry, including doors, windows, vents, electrical openings and any other openings, should be sealed to help prevent contaminants from entering the room. No one, including pets, should leave the room as it is not only dangerous to them but they will also track contaminants back into the shelter.
Call your emergency contact to make them aware of your situation and location. Unless reporting a life-threatening condition, stay off the phone as emergency responders will need all available lines to help in response and recovery efforts.
Keep listening to the radio or television for further information until you are told to evacuate or it is safe to leave your shelter. Do not evacuate until instructed to do so.

What You Need to Shelter-in-Place at Home

Pre-designated room, preferably above ground with few or no windows
Duct tape
Plastic sheeting (e.g. vapour barrier, heavy duty garbage bags)
Scissors
Emergency kit including a working radio
List of emergency contacts
Hard-wired phone if possible
Pet excrement supplies (e.g. litter box, plastic bags, newspaper)

In Your Vehicle

Comfort in your vehicle can be hard at the best of times. Now imagine you are stopped on the side of the road for an extended period of time. Here are a few steps to take when required to shelter-in-place while in your vehicle.

In general, if you are required to shelter-in-place in your vehicle, the following steps are recommended:

If you are extremely close to home, your workplace or public building, go there immediately and seek shelter. Shelter-in-place according to the building’s requirements.
If you are unable to get indoors quickly and safely, pull over to the side of the road. If it is during hotter months, you may want to find a shaded place to park to avoid overheating inside your vehicle.
Turn off your engine and AC/heating.
Close all windows and vents. If possible, seal all vents using duct tape or whatever means available.
Listen to the radio periodically for information and instructions.
If possible, call your emergency contact to make them aware of your situation and location. Unless reporting a life-threatening condition, stay off the phone as emergency responders will need all available lines to help in response and recovery efforts.
Stay where you are until you are told it is safe to go back on the road.

What You Need to Shelter-in-Place in Your Vehicle

Vehicle emergency kit
List of emergency contacts
Games for children

Evacuation

Emergency officials may require you to evacuate when there is a significant threat posed to a specific area. This could be caused by a natural disaster, such as severe weather, or a human-caused accident, such as a chemical release. In any case, consider the following points when preparing for, and during, an emergency evacuation:

Prearrange out–of-area locations to go to when an emergency strikes and evacuation is necessary. Friends or family out of the area may be good candidates.
Only evacuate when directed to do so by emergency officials; staying put may be safer in some instances (e.g. shelter-in-place).
Turn off water, electricity, and gas if officials tell you to do so.
Leave a note telling others when you left and where you are headed if possible.
If ordered to evacuate, be sure to listen to media reports for information on what areas are being evacuated and which routes should be taken.
Offer assistance to neighbours who may be unable to evacuate on their own. Ideally, this scenario should be planned for prior to an emergency. However, make sure you are safe before assisting others.
Take your emergency kit with you.
If you have time, notify your out-of-town emergency contact and tell them where you are going and when you expect to arrive at your destination. Once you are safe, let them know.
Evacuate as directed, using the route that emergency officials direct you to use. Taking short cuts may lead to closed roads or even into more dangerous areas.
Know how to shelter-in-place in your vehicle.
Check points may be set up to inspect for contamination, record evacuee information or arrange for temporary shelter.
Avoid using the telephone unless you are reporting a life-threatening injury or emergency.
Listen to media reports for further information on the situation.
If you go to an evacuation centre, register your personal information and do not return home until authorities have authorized you to do so.
If you have to evacuate your home for a prolonged period of time due to a power failure/loss of heat during colder months, drain the water from your plumbing system. To do so, turn off the main water valve entering your home, run all taps and flush your toilet several times. Also drain your water heater (turning off its pilot light/power source) and unhook washing machine hoses. Consider an alternative power source for sump pumps (e.g. battery powered) to reduce the chance of flooding when its power is lost.

Isolation and Quarantine

Diseases can spread in a variety of ways. Humans can acquire the disease from other people, animals, food, water and even inanimate objects. Public health and medical efforts have attempted to keep such diseases from becoming the cause of major emergencies, such as severe pandemics. However, the ability of bacteria, viruses and other pathogens to quickly evolve and change their infective characteristics has made them a constant threat. Therefore, it is important to understand why and when public health measures such as isolation and quarantine are required.

Isolation

Individuals who are infected with a contagious disease may require isolation from other people. Doing so will help stop the spread of the disease to loved ones, and the community at large. Isolation should last, at a minimum, for the duration of time which the infected individual is capable of passing the disease to another person, also known as the period of communicability. During this time, the isolated person should be in their own room, being cared for by individuals wearing the proper personal protective equipment for the specific illness.

Quarantine

Quarantine of healthy individuals who have been exposed to a contagious disease is a community-based disease control measure that may be considered in order to slow the transmission of the disease in the community. If used, it will likely be most effective in the very early stages of detection of the contagious disease. Individuals identified as contacts may be asked to isolate themselves at home for the incubation period of the disease. During this time, they may be contacted by telephone by public health staff. However, once transmission occurs in the community, this measure will no longer be effective in slowing or containing transmission.

Self-Health Care

It is important to understand that health care services may become overwhelmed (e.g. mass casualties) or inoperative (e.g. hospital destroyed) during an emergency. For this reason, improving your self health care skills and knowledge can play a crucial role in responding to an emergency and may save lives, including your own.

Knowing first aid and CPR can save a life. In order to be better prepared, contact your local St. John Ambulance or Canadian Red Cross for first aid and CPR courses in your area.

When Feeling Ill

A widespread disease (e.g. pandemic) may also result in an emergency situation. Self care may be required under such circumstances, as medical resources may be overwhelmed or authorities have issued home quarantine. Fortunately, depending on the disease and its severity, home treatment and self care may relieve most symptoms and reduce the risk of further problems.

If you start to become moderately ill, these steps may assist you in monitoring and improving your health at home:

Stay home if you are sick. This will ensure that you get the rest you need and that you don’t spread the virus to others.
Drink lots of fluids. Water, 100% juice, milk and herbal teas are best. It is best to avoid drinks with caffeine, alcohol or a high sugar content because they actually make you lose fluid from your body.
Take basic pain/fever relievers, such as acetaminophen (Tylenol) or ibuprofen. Acetylsalicylic acid (ASA or Aspirin) should NOT be given to children or teenagers.
Use a hot water bottle or heating pad. Applying heat carefully, for short periods of time, can help reduce muscle pain. Check the skin often when using a heating pad because the pad can cause burns and blisters.
Take cough medicine if you have a dry cough.
Get lots of rest.
Take a warm bath with Epsom salts.
To ease a sore throat, gargle with a glass of warm water and/or suck on sugar free hard candies or lozenges.
To help soothe or clear a stuffed nose, use saline drops, spray or decongestants.
Avoid alcohol and tobacco. Smoking especially irritates damaged airways.
Avoid sharing anything that may carry germs, such as towels, lipstick, cigarettes, drinks or toys.
Wash your hands often. Use soap and warm water and wash for at least 20 seconds, or use alcohol-based hand rubs if your hands do not look dirty. This will help you avoid spreading the flu to others.
If possible, ask your pharmacist for advice if you buy over-the-counter medicine. Let him or her know if you have any chronic medical problems.
Call someone to help you until you are feeling better. This is especially important if you are alone, a single parent, or are responsible for the care of someone who is frail or disabled. However, if the disease is highly contagious, precautions should be taken to avoid transmitting the disease (e.g. personal protective equipment).
Contact Telehealth (1-866-797-0000) for further advice.
Contact and/or seek medical attention if symptoms become severe or do not subside.

Infection Control Practices

Should the spread of infectious disease result in a severe outbreak or pandemic, instituting simple infection control practices will help protect you and your loved ones from becoming ill. Ideally, these practices should be commonplace in your daily activities. Practicing and using them now will help make them a habit and make you better prepared for when an infectious disease disaster strikes.

Routine Practices

Some infections can be spread through contact with blood, body fluids, excretions and secretions. You cannot tell from looking at people if they have this kind of infection. This is why you need to use “Routine Practices”. Routine Practices prevent contact with the blood, body fluids, excretions and secretions of other people. These practices are the same in all settings, for all people.

Routine practices include the following actions:

Wash your hands:
- Wash your hands using procedures outlined below.
- Wash your hands after sneezing and coughing.
- Wash your hands after using the toilet.
- Wash your hands before and after meals.
- Wash your hands before and after preparing food.
- Wash your hands before and after touching other people.
- Wash your hands after contact with blood, body fluids, excretions and secretions or any soiled articles. Wash them right after removing gloves.
Wear gloves:
- Wear gloves before giving first aid.
- Wear gloves at any other time when your hands are likely to come in contact with blood, body fluids, excretions and secretions, mucous membranes or broken skin.
- Wear gloves when handling soiled items or surfaces.
Clean properly:
- Be careful when you handle soiled materials and equipment so that you don’t soil other things.
- In case of spills of blood or other body fluids, excretions and secretions:
  - Wipe up the spill with paper towels.
  - Sanitize the area using a mixture of one part bleach to nine parts water.
  - Allow the bleach mixture to be in contact with the surface for 10 minutes.
  - Wipe dry with a fresh paper towel.
  - Place soiled clothing and washables in a plastic bag.
  - Seal the bag.
  - Use a second plastic bag if it is likely to leak.
  - Launder as soon as possible in the regular fashion.
  - Wash your hands.
Handle “sharps” (e.g. needles) safely:
- Avoid sharing personal items such as razors.
- Never share needles for injections.
- Place used “sharps”, such as needles used for injections, in a specially designed container.
Use protective barriers as necessary/where possible:
- Wear a gown or apron if your clothing is likely to be soiled with blood or body fluids, secretions or excretions. Remove your gown as soon as possible afterwards, then wash your hands.
- Cover all open or moist cuts or sores with a clean, dry bandage. Replace the bandage if it becomes wet or soiled.
- Protect your eyes, nose and mouth from splashes of blood, body fluids, excretions and secretions. If a splash does happen, wash it away as quickly as possible. See a doctor right away.
- Report incidents. If you are exposed to someone else’s blood or body fluids (e.g., through a needlestick injury, a splash or a human bite that breaks the skin), contact your doctor or local emergency room right away for advice.
- Minimize contact with others and try to stay at least one metre away.

Mental Health

Stressful situations such as emergencies can induce a variety of responses in people, including anxiety, fear, and confusion. Such reactions are natural, but should be understood in order to better deal with loved ones, other people, and even yourself during a crisis. By doing so, you will be better able to identify these natural human reactions that could impact critical decision making and physiological responses to a disaster so that you can adjust, seek help and recover accordingly.

Traumatic Stress Symptoms

Physical	Cognitive	Emotional	Behavioural
Chest pain*	Confusion	Anxiety	Intense anger
Difficulty breathing*	Difficulty communicating thoughts	Guilt	Argumentative
Shock symptoms*	Nightmares	Grief	Withdrawal
Fatigue	Disorientation	Denial	Emotional outburst
Nausea/vomiting	Heightened or lowered alertness	Severe panic (rare)	Temporary loss or increase of appetite
Dizziness	Poor concentration/attention span	Fear	Excessive alcohol consumption
Profuse sweating	Memory problems	Irritability	Inability to rest, pacing
Rapid heart rate	Poor problem solving	Loss of emotional control	Change in sexual functioning
Thirst	Difficulty identifying familiar objects or people	Depression	Unnecessary risk taking
Headaches		Sense of failure
Tremors		Feeling overwhelmed
Visual difficulties		Blaming others or self
Clenching of jaw Nonspecific aches and pains
Unusual clumsiness
Balance problems
*Seek medical attention immediately if you experience chest pain, difficulty breathing, severe pain, or symptoms of shock (shallow breathing, rapid or weak pulse, nausea, shivering, pale and moist skin, mental confusion, and dilated pupils).

Tips to Responding to and Recovering from Traumatic Stress

Physical and emotional reactions to traumatic events including emergencies can vary from one individual to the next. A person’s perception and understanding of such an experience will also change over time. However, no matter what the reaction or event, there are some tips to help you respond to, and recover from, traumatic stress.

Pace yourself in your emergency response and recovery efforts, whether working or simply doing routine activities.
Take frequent rest breaks when working or helping with recovery efforts. Mental fatigue can result in poor, and possibly hazardous, judgement that could impact the health and safety of others and yourself.
Pay attention to loved ones and other people. Others may be intently focused on a particular task and may not notice a hazard nearby or behind.
Get plenty of rest and normal exercise.
Make sure you eat well-balanced meals regularly.
Avoid overuse of drugs or alcohol.
Whenever possible, take breaks (e.g. coffee break) away from the work area.
Recognize and accept that some things are out of your control.
Do not hastily make big life decisions, but make many daily decisions to help give you a sense of control.
Connect with family, friends, and community support systems (e.g. spiritual groups).
Communicate with family as much as possible.
Spend time doing things you enjoy.
Give yourself permission to feel rotten: You are in a difficult situation.
Recurring thoughts, dreams, or flashbacks are normal; do not try to fight them. They will decrease over time.
Talk to people about the traumatic event when you are comfortable to do so. You decide when you want to discuss your experience. Talking about an event may feel like you are reliving it.
Recognize the feeling of fear is normal following a traumatic event, and will pass with time.
Understand that recovery takes time and there will be obstacles along the way.

For more information on dealing with emotional reactions to disasters, visit the following websites:

Canadian Red Cross	www.redcross.ca
Canadian Psychological Association	www.cpa.ca
Public Health Agency of Canada	www.phac-aspc.gc.ca/emergency-urgence
Centre for Disease Control and Prevention	emergency.cdc.gov/mentalhealth/

Related Resources

Shelter-in-Place, Evacuation and Decontamination Instructions