Wednesday, September 20, 2017

#NatlPrep: Because Sometimes It Is Darkest After The Storm

Note: This is day 20 of National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.
This month, as part of NPM17, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones. 

Short term power outages affect most of us each year, usually lasting anywhere from a few minutes to a couple of hours.  Longer outages, while less common, are far from rare - as anyone who found themselves in the path of hurricanes Harvey, Irma, and Marie over the past month will attest.
While my power was restored late last week, there are still a few thousand without power in Florida, and with Marie's landfall a few hours ago, likely millions more are without electricity now in Puerto Rico. 
As so many have recently discovered (or rediscovered), after about 12 hours without electricity, the quality of life begins to sharply decline.  After 48 hours life just sucks.
While having no TV, or Internet, or electric lights might seem more of an inconvenience than anything else, sometimes not having power can be deadly (see Ninth person dead in Florida nursing home where Irma knocked out power).
During the summer of 2012, a powerful Derecho swept across the Mid-Atlantic states (see Picking Up The Pieces), killing 15 and leaving nearly 4 million people without power, some for more than 2 weeks. While 15 people died during the storm, at least 32 died of heat-related illnesses in the two weeks that followed.   This from a 2013 MMWR:
Heat-Related Deaths After an Extreme Heat Event — Four States, 2012, and United States, 1999–2009


June 7, 2013 / 62(22);433-436 On June 29, 2012, a rapidly moving line of intense thunderstorms with high winds swept across the midwestern and eastern United States, causing widespread damage and power outages.
Afterward, the area experienced extreme heat, with maximum temperatures exceeding 100°F (37.8°C) (1). This report describes 32 heat-related deaths in Maryland, Ohio, Virginia, and West Virginia that occurred during the 2 weeks following the storms and power outages. 

Most decedents (75%) were unmarried or living alone. Common underlying or contributing conditions included cardiovascular disease (14) and chronic respiratory disease (four). In at least seven (22%) of the deaths, loss of power from the storms was known to be a contributing factor. Overall, 22 (69%) decedents died at home, with lack of air conditioning reported in 20 (91%) of these deaths.
       (Continue . . . )

As I've written often (see #NatlPrep: Disaster Buddies) people who live alone - nearly 1 person in 10 in the United States - are particularly vulnerable during a disaster.
For some of them, having a place to go when staying put would endanger their safety, and a way to get there, can literally mean the difference between life and death.
Hurricanes, ice storms, Nor’easters, tornadoes, floods, tornadoes . . .  and even solar storms (see Solar Storms, CMEs & FEMA) are capable of crippling power production and delivery.
Add in our aging infrastructure, and the potential of cyber (or physical) attacks on the system, and the odds of seeing more major power outages only increases.
Without electrical power, water and gasoline doesn’t pump, elevators and air conditioners don’t run, ATM machines and banks close, grocery stores can’t take debit or credit cards, produce, meat and frozen foods spoil, and and everything from cooking, to flushing toilets, becomes a major challenge.
Particularly in urban settings. 
If a disaster struck your region today, and the power went out, stores closed their doors, and water stopped flowing from your kitchen tap for the next 7 to 10 days  . . .  do you have:
  • A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials?
  • A decent first-aid kit, so that you can treat injuries?
  • Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration?
  • A way to provide light (and in cold climates, heat) for your family without electricity?   And a way to cook?  And to do this safely?
  • A small supply of cash to use in case credit/debit machines are not working?
  • An emergency plan, including meeting places, emergency out-of-state contact numbers, a disaster buddy,  and in case you must evacuate, a bug-out bag?
  • Spare supply of essential prescription medicines that you or your family may need?
If your answer is `no’, you have some work to do.  A good place to get started is by visiting  
Unfortunately, a lot of people make the wrong choices when they do prepare.  They buy candles instead of battery operated lights, they use generators inside their house or garage, or resort to dangerous methods to cook or to heat their homes. 
As a result, when the power goes out, house fires and carbon monoxide poisonings go up. Each year hundreds of Americans are killed, and thousands affected, by CO poisoning (see In Carbon Monoxide: A Stealthy Killer).  
While preparedness may seem like a lot of work, it really isn’t.  You don’t need an underground bunker, an armory, or 2 years worth of dehydrated food.  But you do need the basics to carry on for a week or two, and a workable family (or business) emergency/disaster plan. 
But you need to make these preparations now, before the next threat appears on the horizon.  In central Florida, there wasn't a case of water, a flashlight, or a battery to be had a full 5 days before Irma struck.  Those who procrastinated were out of luck.

For more information on how to prepare, I would invite you  to visit:

A final note:  Living in Florida, and having endured some mighty uncomfortable power outages, I've come to really appreciate having a battery operated fan in my emergency kit.

The little fan above cost me about $12, runs for roughly 24 hours on 3 D cells, moves a pretty good amount of air, and makes a great little preparedness item. There are also USB fan options, which can run off of USB powerbanks (which in turn can be charged by solar panels).

CDC Update: Candida Auris - September 2017


Last summer (June 24th, 2016) the CDC issued a Clinical Alert to U.S. Health care facilities about the Global Emergence of Invasive Infections Caused by the Multidrug-Resistant Yeast Candida auris.
C. auris is an emerging fungal pathogen that was first isolated in Japan in 2009. It was initially found in the discharge from a patient's external ear (hence the name `auris').  Retrospective analysis has traced this fungal infection back over 20 years.
Since then the CDC and public health entities have been monitoring an increasing number of cases (and hospital clusters) in the United States and abroad, generally involving bloodstream infections, wound infections or otitis (see August Update).
Adding to the concern:
  1. C. auris infections have a high fatality rate
  2. The strain appears to be resistant to multiple classes of anti-fungals  
  3. This strain is unusually persistent on fomites in healthcare environments.
  4. And it can be difficult for labs to differentiate it from other Candida strains
Last month the CDC promoted the first ever Fungal Disease Awareness Week, and presented a COCA call webinar called Tackling an Invasive, Emerging, Multi-drug Resistant Yeast: Candida auris — What Healthcare Providers Need to Know, which is now archived and available online.

CIDRAP's Antimicrobial Stewardship Project (ASP) also held an hour long webinar (see below), which is now available on the CIDRAPASP Youtube channel.
 (Note: you'll find more than a dozen other on-topic videos available on this channel as well).
This week the CDC updated their C. Auris surveillance page, where they now show 126 confirmed cases and 27 probable cases, across 10 states (California was added this month). The number of colonized asymptomatic cases has risen to 143.

Tracking Candida auris

September 18, 2017: Case Count Updated as of August 31, 2017

Candida auris is an emerging fungus that presents a serious global health threat. C. auris causes severe illness in hospitalized patients in several countries, including the United States. Patients can remain colonized with C. auris for a long time and C. auris can persist on surfaces in healthcare environments. This can result in spread of C. auris between patients in healthcare facilities.

Most C. auris cases in the United States have been detected in the New York City area and New Jersey. Strains of C. auris in the United States have been linked to other parts of the world. U.S. C. auris cases are a result of inadvertent introduction into the United States from a patient who recently received healthcare in a country where C. auris has been reported or a result of local spread after such an introduction.

Please note that as of September 18, 2017, the total case counts reported include both probable and confirmed clinical cases; previously reported case counts included only confirmed cases. Case counts for some states are quite a bit higher than those listed before September 18, 2017 because of the change in reporting, and not because of a large increase in new cases. Read more below about how cases are defined.

WHO: The World Is Running Out Of Antibiotics


While pandemics and outbreaks of novel diseases like avian flu, MERS, and Zika make the immediate headlines, in terms of medium-to-long term threats, there is little that can match the potential harm from the rise of antibiotic resistant bacteria around the globe.
Despite decades of warnings, this threat is largely under appreciated by the public because its progression has been gradual, the loss of antibiotics incremental, and so far at least . . . there have always been replacement drugs available when an antibiotic has failed.
But the number of new antibiotics in the pipeline are desperately few, and the pace of newly emerging resistant bugs has increased greatly in recent years. While the numbers remain small, we are beginning to see the emergence of pan-resistant bacteria.

A few (of dozens) of unwelcome antimicrobial resistant milestones reported in the past couple of years include:

Eurosurveillance: Mcr-One, Two, Three And Counting
MMWR: Fatal Pan-Drug Resistant CRE - Nevada 2016
mBio: 1st Colistin & Carbapenem Resistant E. Coli Infection In A U.S. Patient
Eurosurveillance: Identification Of A Novel Colistin-Resistant MRC-2 Gene In E Coli - Belgium, 2016
CDC HAN: Alerting Healthcare Facilities Of 1st MCR-1 Gene Detection In US Patient

And just three weeks ago CIDRAP reported on a Hypervirulent, highly resistant Klebsiella identified in China, one which a week later was described as New Klebsiella strains 'worst-case scenario,' experts say. 
If we're in a war against resistant bacteria, the news from the front isn't good.
Today the World Health Organization released a grim assessment of the current state of antibiotic development, calling on pharmaceutical companies and researchers to `urgently focus on new antibiotics against certain types of extremely serious infections'.

News release 
A report, Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosis, launched today by WHO shows a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance.

Most of the drugs currently in the clinical pipeline are modifications of existing classes of antibiotics and are only short-term solutions. The report found very few potential treatment options for those antibiotic-resistant infections identified by WHO as posing the greatest threat to health, including drug-resistant tuberculosis which kills around 250 000 people each year.

"Antimicrobial resistance is a global health emergency that will seriously jeopardize progress in modern medicine," says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. "There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery."

In addition to multidrug-resistant tuberculosis, WHO has identified 12 classes of priority pathogens – some of them causing common infections such as pneumonia or urinary tract infections – that are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only 8 are classed by WHO as innovative treatments that will add value to the current antibiotic treatment arsenal.

There is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli) which can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

There are also very few oral antibiotics in the pipeline, yet these are essential formulations for treating infections outside hospitals or in resource-limited settings.

"Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence," says Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) set up the Global Antibiotic Research and Development Partnership (known as GARDP). On 4 September 2017, Germany, Luxembourg, the Netherlands, South Africa, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the Wellcome Trust pledged more than €56 million for this work.

"Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years," says Dr Mario Raviglione, Director of the WHO Global Tuberculosis Programme. "If we are to end tuberculosis, more than US$ 800 million per year is urgently needed to fund research for new antituberculosis medicines".

New treatments alone, however, will not be sufficient to combat the threat of antimicrobial resistance. WHO works with countries and partners to improve infection prevention and control and to foster appropriate use of existing and future antibiotics. WHO is also developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.

Note to editors

For more information, download the following reports:
The clinical pipeline analysis data can be explored in an interactive way through:

Tuesday, September 19, 2017

#NatlPrep : Pandemic Planning Considerations

Note: This is day 19 of National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.
This month, as part of NPM17, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones. 


Although we are coming up on the 100th anniversary of the deadliest flu pandemic in history, it is worth noting that there have been 3 legitimate pandemics, and a couple of pseudo-pandemics in my lifetime.  As I’m only 63, there is a pretty good chance I’ll see another one before I exit stage left.

Over the past 60 years we’ve seen:
  • The 1957 H2N2 Pandemic 
  • The 1968 H3N2 Pandemic
  • The 1977 H1N1 `Russian Flu’ pseudo-pandemic
  • The 2003 SARS pseudo-pandemic
  • The 2009 H1N1 Pandemic
We are also in the midst of a slow-rolling HIV pandemic, which nonetheless has claimed the tens of millions of lives, and the 7th Cholera Pandemic (which ran between 1961-1975) still claims tens of thousands of lives each year.
While a lot of pathogens can potentially cause a pandemic, it is novel influenza that has historically wreaked the most havoc, and keeps most epidemiologists up at night.
A decade ago - when the H5N1 bird flu virus first threatened - we saw a massive global push for pandemic preparedness. Many groups selected a CPO; a Chief Pandemic Officer.  Someone in their business, organization, or family - whose job it was to coordinate their pandemic plan  (see Quick! Who's Your CPO?). 
Unfortunately, since the 2009 H1N1 pandemic was perceived by many as being mild and the next event thought years away, many corporate, organizational, or agency pandemic plans haven’t been updated – or in some cases even looked at – in years.
While a pandemic may not strike with the suddenness of an earthquake or a Hurricane, a pandemic virus can still spread around the globe in a matter of days or weeks, leaving precious little time to prepare. 

The CDC, and FEMA continue to urge pandemic preparedness, and earlier this year the CDC updated their CDC/HHS Community Pandemic Mitigation Plan - 2017, which recognizes a vaccine could be months in coming, and focuses on reducing the spread of a pandemic virus through non-pharmaceutical interventions (see Community Pandemic Mitigation's Primary Goal : Flattening The Curve)

The CDC’s Nonpharmaceutical Interventions (NPIs) webpage defines NPIs as:

Nonpharmaceutical interventions (NPIs) are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like influenza (flu). NPIs are also known as community mitigation strategies.
Social distancing, staying home when sick, avoiding crowds, even the closure of schools or other public venues are all potential NPIs.

Although there may be other pharmaceutical options - like antivirals - available at the start of a pandemic, those will be in finite supply and are not a panacea for infection.  Prevention is always better than treatment, but never more so than during a pandemic, when treatment options may quickly become limited.

Hospital beds, ventilators, even hospital staff - may all be in short supply during a pandemic (doctors and nurses get sick, too) - which makes it all the more imperative we flatten the curve - even if it means extending the duration of a pandemic wave.

While telling people to wash their hands, cover their coughs, avoid crowds, and stay home while sick may seem like a weak response to a pandemic - in truth, they (and other more disruptive measures like school closures, cancellation of public events, etc.) may be our most powerful weapons in any pandemic.

But they must be properly applied, else they could do more harm than good.
It's neither practical or desirable to simply shut everything down at the first sneeze, and try to wait out what could be a year (or longer) pandemic. Very few are equipped to do so, and besides, someone has to keep the lights on, deliver the food, refine the fuel, police the streets,  take care of the sick and injured . . . and do the thousands of other things that hold civilization together.
We'll have to find ways to live and work as safely as possible during a pandemic. Else the virus could quickly become the least of our problems.
If you are an employer, you should know that OSHA considers it your responsibility to provide a safe workplace – even during a pandemic - and has produced specific guidance on preparing workplaces for an Influenza Pandemic  along with Guidance for Protecting Employees Against Avian Flu.

Frankly, few businesses could survive a prolonged shutdown due to a pandemic. Which is why pandemic planning should be part of their overall business continuity and recovery plan. A couple of good resources worth checking out are The Business Continuity Daily and Cambridge Risk Perspectives, both of which provide daily reviews of current threats and advice on preparedness.

And if you follow only one link from this blog post, I’d highly recommend the following 20 minute video produced by Public Health - Seattle & King County -  called Business Not As Usual .

We could easily go years, or even decades, before the next pandemic strikes.  Or, it could begin somewhere in the world tomorrow. Like earthquakes along fault lines, and tornadoes in Tornado Alley, pandemics are inevitable. The timing is really the only question.
For a family or an individual - if you are well prepared for a flood, an earthquake, or a hurricane - you are probably in pretty good shape to deal with a pandemic.  Unfortunately, fewer than half of all American households are so prepared.
Businesses, health care facilities, and government agencies will find that their disaster plans will need to consider pandemics a bit more specifically.  For more information on how to prepare, you may want to revisit:
Pandemic Planning For Business
NPM13: Pandemic Planning Assumptions
The Pandemic Preparedness Messaging Dilemma

Monday, September 18, 2017

Maria: Getting Stronger And Aimed At Puerto Rico


With Hurricane Maria today becoming the 4th major hurricane of the 2017 Atlantic season, one is tempted to ask if this sort of thing has happened before.  Unfortunately, the answer is yes.  1961 saw no fewer than 7 CAT 3+ storms, as did 2005. 
And before you ask, 1950 and 1933 both saw 6 major storms.  That we know of, as this was before age of weather satellites.
Meaning that as tired as we already are of this unrelenting hurricane season, with 9 weeks left to go, this year's threat is far from over. Currently in the cross hairs are the already hard hit northern Leeward Islands, the British and U.S. Virgin Islands, followed by Puerto Rico.

The eastern Bahamas are also in the path of this strengthening storm, which is expected to become a CAT 4 in the next 12 to 24 hours.
Although current models appear to keep the storm off the eastern seaboard of the United States, it is far too early to completely write off the threat to the mainland.
So, if you haven’t already downloaded the updated Tropical Cyclone Preparedness Guide, and visited NOAA's Weather-Ready Nation Hurricane Preparedness Week 2017 web page, now would be an excellent time to do so.

When it comes to getting the latest information on hurricanes, your first stop should always be the National Hurricane Center in Miami, Florida. These are the real experts, and the only ones you should rely on to track and forecast the storm.
If you are on Twitter, you should also follow @FEMA, @NHC_Atlantic, @NHC_Pacific and @ReadyGov.

This from the 11am Advisory from the National Hurricane Center.

Hurricane Maria Discussion Number   9
NWS National Hurricane Center Miami FL       AL152017
1100 AM AST Mon Sep 18 2017

Reports from an Air Force Reserve Hurricane Hunter aircraft indicate that Maria is undergoing rapid intensification.  The aircraft reported 700-mb flight-level winds of 115 kt in the northeastern eyewall, along with reliable-looking surface wind estimates from the Stepped Frequency Microwave radiometer as high as 104 kt.  In addition, the estimated central pressure inside the 10 n mi wide eye has fallen to 959 mb.  The initial intensity is increased to 100 kt, making Maria a major category 3 hurricane on the Saffir-Simpson Hurricane Wind Scale.  The small eye is also apparent in radar data from Martinique.

The initial motion is 285/9, a little to the left of the previous motion.  Other than that, there is little change in either the forecast philosophy or the forecast track.  A high pressure area to the north of Maria should maintain a general west-northwestward motion for the next three days or so.  After that, the high weakens, which should allow the hurricane to turn gradually northwestward and north-northwestward.  The new forecast track is changed little from the previous one, and it calls for Maria to move through the Leeward Islands in 12-24 h, approach the Virgin Islands in about 36 h, then cross Puerto Rico between 48-72 h.  The new track lies to the left of the center of the guidance envelope in best agreement with the ECMWF.

Atmospheric and oceanic conditions appear favorable for additional rapid strengthening for the next 24 h and possibly longer. This is reflected in the intensity forecast, which now calls for Maria to become a category 4 hurricane in 12 h and reach a possibly conservative peak intensity of 130 kt in about 36 h.
From 72-120 h, land interaction and less favorable upper-level winds are expected to cause some weakening.  On top of these general trends, there is also the possibility that eyewall replacement cycles could occur that would affect the intensity.  However, Maria is likely to maintain category 3 to 4 intensity through the forecast period.


1. Maria will affect portions of the Leeward Islands and the British and U.S. Virgin Islands as an extremely dangerous major hurricane during the next couple of days, and hurricane warnings are in effect for many of these islands.

2. Maria is likely to affect Puerto Rico as an extremely dangerous major hurricane, and a hurricane watch is in effect for that island. A hurricane warning will likely be issued later today.

3. The potential for a life-threatening storm surge, accompanied by large and destructive waves, has increased for the Leeward Islands, the Virgin Islands, and Puerto Rico.

4. Life-threatening flash floods and mudslides from heavy rainfall are expected across the Leeward Islands, including Puerto Rico and the U.S. and British Virgin Islands.


INIT  18/1500Z 14.7N  60.1W  105 KT 120 MPH
 12H  19/0000Z 15.1N  61.2W  115 KT 130 MPH
 24H  19/1200Z 15.9N  62.6W  125 KT 145 MPH
 36H  20/0000Z 16.8N  64.1W  130 KT 150 MPH
 48H  20/1200Z 17.6N  65.5W  130 KT 150 MPH
 72H  21/1200Z 19.5N  68.5W  125 KT 145 MPH
 96H  22/1200Z 21.5N  71.0W  120 KT 140 MPH
120H  23/1200Z 24.0N  72.5W  110 KT 125 MPH

Forecaster Beven

#NatlPrep: When Its Time To Get Out Of Dodge

Note: This is day 18 of National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.
This month, as part of NPM17, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones. 


Although I've had a couple of close calls over the years, last week's brush with Hurricane Irma was the first time I've actually been forced to leave my home in the face of a natural disaster.  I wrote about my decision 10 days ago in #NatlPrep: Disaster Buddies - The Most Important Prep Of All.
It is not a pleasant thought, but sometimes circumstances and common sense dictate that you must leave your home - and the bulk of your belongings  - behind.
Luckily, I had several prearranged places I can go. Friends, who are also disaster buddies (see In An Emergency, Who Has Your Back?), who know my couch is always available to them should they need it.

Being able to leave in a hurry when an evacuation has been ordered means having a plan, a destination, and an emergency `to go’ kit or `BOB’ already equipped, and standing by. 
In the vernacular, a `bug-out bag'  or `BOB’  (or sometimes GOOD bag for `Get Out Of Dodge’) a bag of emergency supplies, ideally kept at the ready, that one can grab on the way out the door during an emergency.
Every hurricane season I go through my personal bug out bag, and replace flashlight and radio batteries from last year, and swap out older emergency rations for newer ones.
A BOB isn't supposed to be a survival kit, but rather, is supposed to provide the essentials one might need during the first 72 hours of a forced, and sometimes unexpected, evacuation. 
It should contain food, water, any essential prescription medicines, copies of important papers (ID's, insurance, important Phone #s), a first aid kit, portable radio, flashlight, extra batteries, and ideally blankets and extra clothes. 
While having to evacuate your home may seem like an unlikely event, every years hundreds of thousands of Americans are forced to do so.  Rivers spill their banks, dams break, brush fires rage out of control, even sudden industrial accidents can force evacuations. 
And unlike with a hurricane, you won’t always have advance warning. has the following advice on how to prepare for an evacuation, after which I'll have some notes on what I would do differently next time.

 Evacuating Yourself and Your Family

There may be conditions under which you will decide to get away or there may be situations when you are ordered to leave. Follow these guidelines for evacuation:
  • Plan places where your family will meet, both within and outside of your immediate neighborhood. Use the Family Emergency Plan to decide these locations before a disaster.
  • If you have a car, keep a full tank of gas in it if an evacuation seems likely. Keep a half tank of gas in it at all times in case of an unexpected need to evacuate. Gas stations may be closed during emergencies and unable to pump gas during power outages. Plan to take one car per family to reduce congestion and delay.
  • Become familiar with alternate routes and other means of transportation out of your area. Choose several destinations in different directions so you have options in an emergency.
  • Leave early enough to avoid being trapped by severe weather.
  • Follow recommended evacuation routes. Do not take shortcuts; they may be blocked.
  • Be alert for road hazards such as washed-out roads or bridges and downed power lines. Do not drive into flooded areas.
  • If you do not have a car, plan how you will leave if you have to. Make arrangements with family, friends or your local government.
  • Take your emergency supply kit unless you have reason to believe it has been contaminated.
  • Listen to a battery-powered radio and follow local evacuation instructions.
  • Take your pets with you, but understand that only service animals may be permitted in public shelters. Plan how you will care for your pets in an emergency.

While I keep the requisite `bug out bag' (several duffels, in fact), something I hadn't given enough thought to is what would I take if I had 24 hours warning.  It's one thing to flee a burning house with your BOB and your life, it's another thing to have a full day to triage your preps and your life's belongings. 
Ninety-five percent of what I took were emergency supplies, since even where I was going was forecast to be hard hit. But I had to leave a lot behind, partially because I had no good way to pack and tote the stuff.
High on my list of things to get before the `next time' are more duffel bags.  In fact, I'm headed out this morning to hit the thrift stores to buy up what I can find.  And most of my emergency supplies are going to be kept pre-packed, and stored in these bags. 
I'll tag (or color code) these bags as `Essential', `Nice to Have', or `Optional'.  And load my car accordingly. 
I managed to pack one of my 40 watt solar panels, a spare 12 volt (tractor) battery, and my homebrew USB charging station, but it was bulky, heavy, and a bit overkill. Instead, I'm going order a folding solar panel with a USB battery bank for bug-out purposes.
Despite being well prepared to shelter in place, I found I was less organized than I needed to be to evacuate the bulk of my preps.  And that added both work and stress my evacuation.
Luckily, I now have a second chance to remedy that.