Information from the ADA's disaster recovery guide and the EPA's information on safely returning to a business or home after disaster.
The American Dental Association Guide for Disaster Planning and Recovery, available in full online, specifies the following:
Natural Disaster: Floods
Many communities throughout the U.S. are prone to flooding. Floods may occur following spring rains, heavy thunderstorms or winter snow thaw. A dam failure could produce a catastrophic flood.
Before a flood occurs If possible, a dentist or the building owner should consider turning off all equipment from the main power cut-off switch and closing the main gas valve into the facility. If there is sufficient warning, consider moving patient records, computers, easily moved equipment, furniture or supplies to a higher floor or to a location outside of the expected flood area. In an emergency situation, be prepared to abandon the building if necessary or if requested to do so by authorities. Relocate immediately to higher ground out of reach of the flood.
Learn about your community's warning sirens and become familiar with the following terms:
• Flood Watch - Flooding is possible. Stay tuned to NOAA radio1 or commercial radio or television for additional information.
• Flash Flood Watch - Flash flooding is possible. Move to higher ground. A flash flood could occur without any warning. Listen to NOAA radio or commercial radio or television for additional information.
• Flood Warning - Flooding is occurring or will occur soon. If advised to evacuate, do so immediately.
• Flash Flood Warning - A flash flood is occurring. Seek higher ground on foot immediately.
• Urban and Small Stream Advisory - Flooding of small streams, streets and low-lying areas is occurring.
During a Flood
A good idea during a natural emergency is to continue listening to local radio for news updates about the disaster or for instructions about what to do, where to go or what places to avoid during the emergency. Listening to news reports from the radio or television is an excellent way to monitor the situation and could help to explain the delay or inability of patients and staff to get to the office. During periods of flooding, the National Weather Service's river-forecast centers issue forecasts for the height of the flood crest, the date and time when the river is expected to overflow its banks, and the date and time when the flow of the river is expected to recede to within its banks.
Do not attempt to walk, swim or drive an automobile through swift-moving water. As little as six inches of fast-moving flood water can knock a person down. Two feet could float an average-size car.
After the flood
Do not re-visit the flood area until after authorities announce that it is safe to return. In the vicinity of the flood, be on the lookout for hazards, especially downed power lines, as electrocution is a leading cause of death in a flood. Other hazards are displaced poisonous snakes in some regions, and slips and falls. When first entering a recently inundated building, use special caution, as floors are usually still slippery. If your building appears to be structurally weakened, you should probably exit the building immediately and alert authorities.
Asbestos Repairs, renovation or demolition could release harmful asbestos fibers in older construction. Asbestos in the past was used around pipes and in roofing felts, dry wall, floor tiles, and coatings on ceiling. Following a flood, you may need a professional to help you evaluate how to safely remove existing asbestos since asbestos inhalation is known to cause several deadly diseases including asbestosis, which is a progressive and often fatal lung disease; and lung and other cancers.
Lead paint Similarly, repairs that produce airborne concentrations of lead from old painted surfaces can be potentially dangerous. Lead is a heavy metal that can cause damage to the nervous system, kidneys, blood forming organs, and to the reproductive system if inhaled or ingested in dangerous quantities. Sanding surfaces containing lead-based paints with no breathing protection could result in the release of airborne particles of this metal that could be harmful if inhaled.
Fungi and spores Another source of potential illness for a cleanup worker is from exposure to airborne fungi and their spores. Dust particles that might contain fungal material often accompany decaying vegetable matter and fungus-contaminated debris handled by workers clearing debris. Signs and symptoms of illness from fungi include shortness of breath, muscle aches, fever and pain behind the breastbone, and other flu-like symptoms. Onset of symptoms can occur within 4 to 6 hours and could last up to 16 hours. Recovery is usually uneventful.
Patient records In a dental practice that is primarily using paper patient records, the wet flood-damaged paper dental records could present unique problems since for reasons of continuity of care, nothing generally can substitute for the completeness of the original record. In a court case, for example, the original dental record is usually favored over copies as the "best evidence" of the patient's dental history, clinical examination data, diagnosis, treatment plan, informed consent, notes and treatments. A dentist will likely want to recover these damaged records if at all possible.
In a disaster, a practice may have fiduciary responsibilities with respect to reasonably protecting the patient treatment information (dental health records) in its possession irrespective of whether the information is held in an electronic or a paper format. Having a written emergency action & disaster recovery plan could be one way of demonstrating due diligence with regard to helping ensure the survival of the dental health records.
For risk management purposes, protecting from destruction, or restoring and keeping as much of the original record as possible in accordance with a plan, could be of paramount importance to quickly resuming normal operations for a dental practice that has suffered in a disaster.
Recovering wet dental records following a flood or fire The Centers for Disease Control and Prevention ("CDC") Washington, DC recommends the use of gloves while handling wet, flood-soaked paper records. However, at this time, the CDC does not make any recommendation about a need to disinfect wet records beyond drying them since according to them, the waterborne microorganisms that might cause disease in humans generally are not absorbed through intact skin and would probably need to be ingested to cause harm.
The Northeast Document Conservation Center ("NEDCC") Andover, Massachusetts is a nonprofit, regional conservation center with the mission of improving preservation programs at libraries and museums. This organization grew out of the collected concern of collections-holding institutions in the northeast faced with the problem of deteriorating historical collections. NEDCC is nationally and internationally known as a premier facility specializing in paper-based conservation treatment and preservation education.
This organization made available some excellent recommendations for recovering water-damaged business records that are incorporated into an inexpensive publication from the American Records Management Association ("ARMA"), titled, "Handbook for Recovery of Water-Damaged Record." (Information about how to order the publication or to contact NEDCC is in the Resources section.)
NEDCC's Field Service program provides free 24 hour disaster assistance consultations to institutions and individuals by telephone (978-470-1010) through a grant from the National Endowment for the Humanities. At the time of a disaster, they may be able to give you a nearby referral or offer recovery advice about damaged business records. NEDCC also handles calls from museums and libraries that suffer damage to their historic documents or paintings. It could be important to the success of your recovery effort with water-damaged or fire/smoke-damaged dental records to know as soon as possible what to do or who near you might be able to provide professional recovery help.
In general, soaked paper records begin to deteriorate within 3 hours and may completely dissolve in 4-5 days. Important water-damaged paper records that you want to recover should be frozen and freeze or vacuum dry, according to experts, within the first 10 hours. Freeze drying of frozen materials converts the frozen water to a gas (sublimation) and by-passes the liquid state altogether. In conjunction with a vacuum, it is said that the process can be highly successful in recovering wet paper records.
A simpler, though less effective method for recovering a small number of wet paper records before molds or mildew set in is called "interleaving." Basically, absorbent sheets (such as white florist's waxed paper or 25% bond or high quality rag paper, or even unprinted paper towels) are placed between the wet sheets in order to hasten the drying process.
Here are some basic recommendations from practicing conservators for recovering water-damaged, paper business records and dealing with mold and mildew 2:
• Lower the temperature and humidity (ideal: 50 - 70 degrees F. and 40 -50% relative humidity), and increase air circulation to reduce the growth of molds. Use moderate room lighting to inhibit mold growth • Avoid packing water-damaged paper records in sealed plastic bags that could promote mold formation • Use protective clothing such as disposable gloves, eye protection and a respirator with particulate filter, as inhaling molds could cause serious illness • Air dry wet records away from direct sunlight or heat that could cause buckling and warpage from too rapid drying • Fumigants that destroy molds and fungi are potentially harmful and should only be handled by those trained in their use.
Supplies and equipment Do not re-sterilize flood-damaged, pre-packaged paper sterile products such as surgical gauze, paper points, gloves, bandages, etc. as manufacturers generally do not warranty these items for sterility once they are wet or remain open. Replacing most flood damaged paper-wrapped supplies is relatively inexpensive and is your safest course of action.
Permanent dental equipment that is inundated, on the other hand, cannot so easily be discarded even though an extended soaking under water usually renders most equipment irreparable. However, once the waters recede and everything is dry, an experienced technician should inspect all of your equipment to determine serviceability. For example, it might be possible to re-condition a dental chair's motor, reupholster the chair and armrest with new vinyl or cloth and still achieve a significant cost saving over an all-new replacement, especially if there is inadequate or no flood insurance. Contact your dental equipment dealer for more information about inspecting and reconditioning damaged dental equipment.
Microbes in floodwater Examine tap water closely before use. For instance, water that is cloudy, that smells or tastes bad probably should not be consumed. If necessary, allow at least 5 minutes of boiling time to make suspicious water safer for use (see Boil-water Advisories in the section that follows).
To inspect the practice following a flood that came into your office, wear protective clothing. However, do not wear your flood-soiled garments home as floodwater can come in contact with sewage. As such, floodwater is regarded as potentially infectious. Which is why any cuts or wounds you have that come into contract with flood water should be disinfected. Getting contaminated flood water into eyes, mouth or allowing it to contact bare or broken skin could result in illness.
The infectious organisms in floodwater according to a U.S. Department of Labor Occupational Safety and Health Administration ("OSHA") ALERT bulletin, could include intestinal bacteria such as E. coli, Salmonella and Shigella, Hepatitis A virus, and agents of typhoid, paratyphoid and tetanus. Vomiting, diarrhea, abdominal cramps, muscle aches and fever, according to the bulletin, could be signs and symptoms of illness from swallowing and becoming contaminated by floodwater. Giardiasis is an example of a sickness caused by a parasite that gets into contaminated water.
If necessary, wear boots and goggles or safety glasses for eye protection. Impervious latex or vinyl gloves may be needed for cleaning up solid chemicals or water-based solutions. (Note: NOT recommended for organic chemicals.) Oil or chemical wastes could get into flood water as well.
In general, headaches, skin rashes, dizziness, nausea, excitability, weakness and fatigue could be symptoms associated with chemical poisoning from tainted floodwater. Some common illnesses connected with sewage-contaminated water are tetanus, hepatitis, dysentery and food poisoning.
A tetanus vaccination might be needed (depending on an individual's vaccination history) if broken skin has come in contact with floodwater. Check with your personal physician if exposed.
Resume normal patient care using tap water only after the water supply is declared safe by authorities. However keep in mind, that in addition to water for sinks and drinking fountains, the high speed dental handpiece, water spray and the ultrasonic dental scaler---all usually use tap water that could have become contaminated during the flood. Follow your manufacturer's recommendation for clearing lines and sterilizing these items.
The following information is taken verbatim from the suggested procedures for dental offices during boil-water advisories of the U.S. Department of Health and Human Services ("HHS"), Centers for Disease Control and Prevention ("CDC").
Suggested Procedures For Dental Offices During Boil-Water Advisories
The Division of Oral Health, which is part of the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention ("CDC"), suggests that the following procedures may be appropriate for dental offices during boil-water advisories. These procedures should be observed in addition to specific instructions issued by state or local health departments during these advisories.
While a boil-water advisory is in effect:
• Water from the public water system should not be delivered to the patient through the dental unit*, ultrasonic scaler, or other dental equipment that uses the public water system until the boil-water advisory is canceled. • Patients should not use water from the public water system for rinsing but should use water from alternative sources, such as bottled or distilled water • Dental workers should not use water from the public water supply for hand washing. Instead, antimicrobial-containing products that do not require water for use, such as alcohol-based hand rubs, can be used until the boil-water notice is canceled. These products have been reviewed and cleared for marketing by the U.S. Food and Drug Administration ("FDA").
When the boil-water advisory is canceled: • First, incoming public water system water lines in the dental office should be flushed (i.e., cleared of contaminated water). All faucets in the dental setting should be turned on completely for at least 30 minutes, including water lines to dental equipment that uses the public water system. • After the incoming public water system water lines are flushed, dental unit water lines should be disinfected. The dental unit manufacturer should be consulted to determine the appropriate procedures to disinfect the dental unit water lines.
Because water from the affected public system should not be delivered to the patient during a boil-water advisor, many dental procedures cannot be performed. Alternative water sources, such as separate water reservoirs that have been cleared for marketing by the FDA, can be used. However, if the alternative water source were to flow through a dental unit previously connected to the affected public water supply, the dental unit water lines should first be flushed and disinfected according to the manufacturer's instructions.
ENVIRONMENTAL PROTECTION AGENCY FACT SHEET
RETURNING TO HOME OR BUSINESS AFTER DISASTER
When citizens are authorized by local authorities to return to their homes and businesses, federal authorities urge people to take the following precautions:
General Cautions when Re-entering Hurricane-Damaged Homes and Buildings
EPA urges the public to be on the alert for leaking containers and reactive household chemicals, like caustic drain cleaners and chlorine bleach, and take the following necessary precautions to prevent injury or further damage:
- Keep children and pets away from leaking or spilled chemicals.
- Do not combine chemicals from leaking or damaged containers as this may produce dangerous or violent reactions.
- Do not dump chemicals down drains, storm sewers or toilets.
- Do not attempt to burn household chemicals.
- Clearly mark and set aside unbroken containers until they can be properly disposed of
- Leave damaged or unlabeled chemical containers undisturbed whenever possible.
Individuals should exercise caution when disturbing building materials to prevent physical injury or other health effects. Building materials may contain hazardous materials such as asbestos that when carried by the air can be breathed in and cause adverse health effects. If it is suspected that asbestos containing materials may be present, they should not be disturbed. Asbestos containing materials include the following:
- boiler/pipe insulation
- floor tiles
- asbestos roofing
- transite boards used in laboratory tabletops and in acoustics in auditoriums, music rooms and phone booths
Federal, state and local personnel are being deployed to the hurricane-affected areas to establish debris-management programs, including household hazardous waste collection and disposal programs. These efforts may take days or weeks to come to all communities. In the meantime, EPA urges the public to exercise caution and report concerns to local environmental, health and waste disposal authorities.
Be Aware of Possible Combustible or Explosive Gases -Many natural gas and other fuel lines were broken during Hurricane Katrina and highly explosive gas vapors may still be present in many buildings. In addition, methane and other explosive gases may accumulate from decaying materials.
Open all windows when entering a building. If you smell gas or hear the sound of escaping gas:
- Don't smoke, light matches, operate electrical switches, use either cell or conventional telephones, or create any other source of ignition.
- Leave the building immediately; leaving the door open and any windows that may already be open.
- Notify emergency authorities. Don't return to the building until you are told by authorities that it is safe to do so.
Avoid Carbon Monoxide Poisoning - Carbon monoxide (CO) is a colorless, odorless gas that is produced when any fuel is burned and that can kill you at high levels.
- Do not use fuel-burning devices such as gasoline-powered generators, gasoline-powered pressure washers, camp stoves and lanterns, or charcoal grills in homes, garages, or any other confined space such as attics or crawl spaces, or within 10 ft. of windows, doors or other air intakes. Opening doors and windows or using fans will not prevent CO buildup in the home. Have vents and chimneys checked to assure that debris does not block or impede the exhaust from water heaters and gas furnaces.
- If you start to feel sick, dizzy or weak while using a generator, get to fresh air right away. The CO from generators can readily lead to full incapacitation and death.
Avoid Problems from Mold, Bacteria and Insects -Standing water is a breeding ground for a wide range of micro-organisms and insects, such as mosquitoes. Mosquitoes can spread diseases like West Nile Virus. Micro-organisms, including bacteria and mold, can become airborne and be inhaled. Where floodwater is highly contaminated, as it is in many areas of the Gulf Coast, infectious disease is of concern.
- Remove standing water as quickly as possible.
- Remove wet materials and discard those that cannot be thoroughly cleaned and dried, ideally within 48 hours. While smooth, hard surface materials such as metal and plastics can often be cleaned effectively, virtually all building contents made of paper, cloth, wood and other absorbent materials that have been wet for longer than 48 hours may need to be discarded as they will likely remain a source of mold growth.
- Dry out the building. The heavily contaminated flood waters resulting from Hurricane Katrina containmicro-organisms and other contaminants that can penetrate deep into soaked, porous materials and later be released into air or water. Completely drying out a building that has been immersed in contaminated flood waters will take time and may require the extensive removal of ceiling, wall, insulation, flooring and other materials as well as, in some cases, extensive disinfection. The growth of micro-organisms will continue as long as materials remain wet and humidity is high. If a house or building is not dried out properly, a musty odor, signifying growth of micro-organisms, can remain long after the flood. When fumes are not a concern and if electricity is available and safe, closing windows and running a dehumidifier or window air conditioner can be an effective way to remove moisture if the damage is moderate.
- Reduce your exposure to air and water contaminants. Every effort should be made to limit contact with flood water. This includes the breathing of water vapors or mists formed from the contaminated water; this may occur when water is pumped or sprayed. If removing materials or furnishings already contaminated with mold or when cleaning significant areas of mold contamination or generally disinfecting areas soiled by flood waters, federal authorities recommend limiting your exposure to airborne mold spores by wearing gloves, goggles, and wearing an N-95 respirator, if available, or a dust mask.
Avoid Problems from the Use of Cleaners, Disinfectants, and Pesticides - Disinfectants, sanitizers, and other pesticides can contain toxic and potentially hazardous substances.
- Mixing certain types of household cleaners and disinfectants can produce toxic fumes and result in injury and even death. Do not mix them or use them in combination.
- Read and follow all label instructions carefully.
- Provide fresh air by opening windows and doors. Remain in a room no longer than necessary. Allow adequate time for the area to air out.
- If there is no standing water in the building and it is safe to use electricity, use fans both during and after the use of disinfecting, cleaning, and sanitizing products. Be sure that before using any electrical appliances, that they are properly grounded, and where possible, connected to a ground break equipped electrical source.
- Keep all household products locked, out of sight and out of reach of children. Use child-resistant packaging properly by closing the container securely after each use. Keep items in original containers. Call 1-800-222-1222 immediately in cast of poisoning.
EPA Urges Avoiding Problems from Airborne Asbestos and Lead Dust -Elevated concentrations of airborne asbestos can occur if asbestos-containing materials present in many older homes are disturbed. Pipe or other insulation, ceiling tiles, exterior siding, roof shingles and sprayed on-soundproofing are just some of the materials found in older buildings that may contain asbestos. Buildings constructed before 1970 are more likely to contain asbestos. Airborne asbestos can cause lung cancer and mesothelioma, a cancer of the chest and abdominal linings. Lead is a highly toxic metal which produces a range of adverse health effects, particularly in young children. Many homes built before 1978 may contain lead-based paint. Disturbance or removal of materials containing lead-based paint may result in elevated concentrations of lead dust in the air.
- If you know or suspect that your home contains asbestos or lead-based paint and any of these materials have been damaged or will otherwise be disturbed during cleanup, seek the assistance of public health authorities and try to obtain help from specially trained contractors, if available.
- If possible, removed materials should be handled while still wet or damp, double bagged and properly labeled as to contents.
- In handling materials that are believed to be contaminated with asbestos or lead, EPA recommends that, at a minimum, you wear gloves, goggles, and most importantly, OSHA-approved respiratory protection, if available.
- While still wearing a mask, wash hands and clothing after handling such materials.
- If at all possible, avoid activities that will generate dust, such as sweeping or vacuuming debris that may contain asbestos or lead.
- Take precautions before your contractor or you begin remodeling or renovations that disturb surfaces that may contain lead-based paint (such as scraping off paint or tearing out walls):
- Have the area tested for lead-based paint.
- Do not use a belt-sander, propane torch, heat gun, dry scraper, or dry sandpaper to remove lead-based paint. These actions create large amounts of lead dust and potentially harmful fumes.
- Temporarily move your family (especially children and pregnant women) out of the apartment or house until the work is done and the area is properly cleaned. If you can't move your family, at least completely seal off the work area.
Properly Dispose of Waste - Caution must be exercised to assure that all waste materials are removed and disposed of properly. Open burning of materials by individuals should be avoided. Improperly controlled burning of materials not only represents significant fire hazards but can also produce additional hazards from the vapors, smoke, and residue that are produced from the burning.