Chronic Disease Management in Emergencies

When disasters strike, the immediate focus is on acute injuries and infectious disease outbreaks. But for millions of people living with chronic conditions like diabetes, heart disease, asthma, and hypertension, an emergency can mean a dangerous and often deadly interruption in care. While these conditions may not seem as urgent as traumatic injuries, a lack of consistent management can lead to severe complications, hospitalizations, or even fatalities.

3/6/20253 min read

The Hidden Crisis in Disasters

Unlike traumatic injuries that demand immediate medical attention, chronic diseases require continuous management. Patients rely on regular medication, specialized medical devices, and access to healthcare providers to keep their conditions stable. When an emergency disrupts this delicate balance, the consequences can escalate quickly:

Medication shortages – Supply chain breakdowns, pharmacy closures, and transportation challenges can make it impossible for patients to access essential medications like insulin, blood pressure medicine, or inhalers. Many patients depend on specific brands or formulations, and substitutions may not always be available or effective.
Limited access to healthcare providers – Many healthcare facilities close or become overwhelmed, leaving chronic disease patients without access to routine care, prescription refills, or check-ins with medical professionals. This is particularly concerning for conditions that require frequent monitoring, such as diabetes or heart failure.
Disruptions in power and medical equipment use – People who rely on medical devices such as oxygen concentrators, dialysis machines, CPAP machines, or insulin pumps face life-threatening risks when power outages or infrastructure failures prevent them from using their essential equipment.
Increased stress and environmental triggers – Disasters can worsen conditions like asthma or heart disease due to exposure to smoke, poor air quality, and extreme temperatures. Stress and lack of sleep can further aggravate conditions such as high blood pressure and autoimmune diseases, leading to flare-ups or serious episodes.

The Cascading Effects of System Failures

When chronic disease management breaks down in an emergency, the ripple effects can be felt across the entire healthcare system. Hospitals and emergency rooms, already burdened with disaster-related injuries, must also handle a surge of patients experiencing complications from unmanaged chronic conditions.

For example, individuals with diabetes may suffer from dangerously high blood sugar levels due to missed insulin doses. People with high blood pressure or heart disease may experience spikes that increase their risk of heart attacks or strokes. Those dependent on dialysis can face life-threatening fluid buildup if their treatments are delayed.

Case Studies: The Real-World Impact

In the aftermath of Hurricane Maria in Puerto Rico, thousands of people with diabetes faced severe health complications due to a lack of insulin access and refrigeration. Many were forced to ration their medication or go without it entirely, leading to emergency room visits, increased rates of diabetes-related amputations, and life-threatening health crises. People with high blood pressure struggled without their medication, increasing their risk of stroke and heart failure. Additionally, individuals reliant on oxygen concentrators or ventilators suffered as power outages rendered their equipment useless, leaving them unable to breathe properly.

Similarly, during winter storms in Texas, dialysis patients struggled to receive life-saving treatments when clinics closed due to power outages. Without regular dialysis, toxins accumulated in their bodies, leading to severe complications, emergency hospitalizations, and fatalities. Many patients attempted to seek care in overwhelmed emergency departments, but hospitals already dealing with weather-related injuries were unable to meet the demand. This situation underscored the critical need for backup power solutions and alternative treatment sites during widespread power failures.

Beyond natural disasters, the COVID-19 pandemic also highlighted how fragile chronic disease management can be during prolonged emergencies. Many patients delayed or avoided routine medical care due to lockdowns, overwhelmed healthcare facilities, or fear of exposure to the virus. The result was an increase in undiagnosed and untreated conditions, leading to worsening complications that required more intensive interventions later. People with heart disease, for example, faced higher rates of severe heart issues due to missed monitoring and treatment adjustments. Meanwhile, disruptions in medication supply chains forced patients to switch to alternative drugs, some of which were less effective or had different side effects, further complicating disease management.

These case studies illustrate how system failures in emergencies disproportionately impact people with chronic conditions. Without targeted preparedness measures, already vulnerable populations will continue to face avoidable risks, further straining healthcare systems and leading to preventable health crises.

What Needs to Change?

To prevent chronic disease care from collapsing during disasters, emergency managers and public health professionals must incorporate proactive strategies to ensure continuity of care. Key considerations include:

Strengthening emergency medication access – Stockpiling essential medications at community hubs, ensuring pharmacies have emergency dispensing protocols, and improving communication around prescription refills during disasters.
Expanding telehealth and mobile clinics – Providing virtual or mobile healthcare access can help bridge gaps when physical facilities are unavailable, especially for those who need routine monitoring or check-ins with medical professionals.
Integrating chronic disease care into emergency preparedness – Disaster response plans must account for chronic disease management, not just trauma care. Shelters and relief efforts should include provisions for those with ongoing medical needs, including refrigeration for medications and charging stations for medical devices.
Ensuring resilient medical supply chains – Building redundancy into supply chains can prevent critical shortages during crises. Partnerships between governments, healthcare providers, and pharmaceutical companies can help ensure that medication distribution remains stable even in the face of disruptions.
Community-based preparedness efforts – Educating individuals with chronic conditions on emergency preparedness, such as maintaining extra medication supplies, knowing alternative care locations, and having backup power options, can help mitigate risks when disaster strikes.

Strengthening Community Resilience

The breakdown of chronic disease management in emergencies is not just a side issue—it is a major public health challenge that needs stronger attention. By integrating chronic disease care into disaster planning and response efforts, emergency managers can help reduce unnecessary suffering, prevent avoidable complications, and strengthen overall community resilience.