BOB - Bug Out Bag, Go-Bag,

[Jay6]

One of my “other duties” is distaster preparation. There have been issues all over the USA in regard to disasters, evacuations, floods, storms, wildfires, and the list goes on. In another social group the question of what do you put in an Emergency Kit, Go-Bag, BOB (Bug Out Bag). This list has been fince tuned by endo’s, paramedics, pumpers, CDCES (fka CDE), & disaster emergency shelter managers.

Currently, there is development off the coast of northern South America with the potential for SE USA impact in the next 10-15 days.

GO-BAG
INSULIN PUMP USER’S EMERGENCY KIT

Work with your pump trainer & doctor for this kit’s inventory. Below is emergency kit inventory & you should plan enough for 30-day evacuation. Check contents monthly.

1. BG testing supplies: meter, strips, lancets, batteries, and control solution.

2. Fast acting carbohydrate to treat low BG.
   

3. Extra snack for longer coverage that fast-acting carbohydrates including protein, & fat.
   

4. Glucagon emergency kit or equivalent – minimum 2.
   

5. Ketone measurement supplies – if history of elevated ketones or MD advice.
   

6. Anti-emetic drug of choice (what you and your pump team believe best).
   

7. Anti-nausea and/or other drugs (what you and your pump team believe best).
   

8. Non-latex gloves – 10 pair & N95 masks – 10 each.
   

9. OTC meds: NSAIDs, triple antibiotic ointment, (what you and your pump team believe you may need).
   

10. Rapid-acting insulin & syringes or insulin pen & needles. (Enough for 30 days)
    

11. Long-acting insulin & syringes or insulin pen & needles. (Enough for 30 days)
    

12. Charging gear and/or batteries for 30 days.
    

13. Insulin pump – spare parts (port covers, battery caps, etc.)
    

14. CGM sensors . (Enough for 30 days) (rotate after acquisition of new supplies)
    

15. Spare CGM transmitter (rotate after acquisition of new supplies)
    

16. Pump packs – everything you use for a POD or cartridge & site change in a Ziplock® sealable plastic bag (Enough for 30 days)
    

a. PODs or infusion set &
b. Insulin pump cartridges
c. Syringe & needle used for cartridge filling
d. Skin prep supplies - alcohol swabs and skin preps
e. Site dressing
f. Tongue blade
17. Diabetes medical alert identification or jewelry (should be wearing/carrying)
18. Insurance card(s) – also copy in phone’s photos or electronic wallet.
19. Surgical marker or “Sharpie®” pen to mark location of a lost CGM wire, etc.
20. A list of current medications (both brand & generic names) including dose and when taken. Your pharmacist can help with this and possibly provide a document to get medications filled away from home in an emergency.
21. A list of your emergency contacts, including address, telephone, & email.
22. PROTOCOLS for managing pump, sites, hypoglycemia, and hyperglycemia - including on & off pump instructions and supplies.
23. Tape &/or over-patches used to secure pump sites & CGMs
24. Blade razor to remove hair if needed to prepare a site for pump or CGM.
25. Power block or other USB power source to recharge pump if electricity is out.
26. Gauze pads to hold pressure or cover bleeders.
27. Stain removal pen(s) to remove blood stains from bleeders, etc.
28. Flashlight
29. Any other items you and your pump team believe helpful.

Consider a weatherproof case like the Pelican iM2450 Storm Case or the Harbor Freight Apache 4800 Weatherproof Case for egress in hostile weather situations.

RATIONALE:

Why 30 days. There have been several disasters (floods, wildfires, earthquakes, hurricanes, etc.) or similar events in the recent past in the USA and globally where evacuations and other circumstances have necessitated rapid relocation. This list has been made in consultation with endocrinologists, CDECS, pump trainers, nurses, paramedics, and disaster shelter managers.

PUMP SETTINGS & INSULIN DOSING

Pump settings for morning, noon, & evening (consider printout from your data website like Diasend, Tidepool, tConnect, etc.)
[a] Basal
[b] insulin to carb
[c] correction factor AKA
Insulin sensitivity

Thoughts?

[John58]

@Jay6

Your pharmacist can help with this and possibly provide a document to get medications filled away from home in an emergency.

I carry paper copies of insulin prescriptions signed by my endo with “substitutions permitted” when traveling, would be worth adding to your list. Alternately I have considered moving all my prescriptions to a chain like CVS or Walgreens in case I get stuck away from home and need a refill.

[Robyn_H]

We’re “preppers” in this household. Preparedness had shaped our homesteading lifestyle. When WWIII breaks out, or the economy collapses, or natural disaster strikes… We’re gonna be okay. (The scope of what my husband saw traveling the world as a private pilot for hire made him really uncomfortable, so we made some major life changes.) I’m having a bit of a hard time with this particular list, though. So much good advice and good intention here… but a little bit confused, too. Seems like it’s looking for everything a diabetic might want, not need. It has some extras not entirely related to diabetes, but it’s also not an inclusive list, so I’m not quite sure why they get a special mention if these items are just meant to be diabetic extras. And I’m really surprised no mention about water, given how critical it is glucose management… And that it’s the most underestimated resource in survival strategies.

Can we at least not call it a Bug Out Bag, but rather an Evacuation Kit? There’s a big difference between plans to Shelter In Place (SIP)/Evacuation Kits (EK), and Bug Out Bags.

Bug Out Bags are very specifically the bare minimum you need to survive the unexpected short-term, generally 3-4 days. They’re also called 100-hour kits for this exact reason. The expectation is that you can get to safety, or rescue can come to you, within 3-4 days, where you’ll have access to further amenities. They are intended to be bare minimum, no frills, survival strategies, so that they remain compact, accessible, and portable. They should really live in your car and go wherever you do, and be small enough that you never once say, “I’ll just leave that home today, since it’s taking up so much space.” A BOB should do just that, FIT IN A BAG, including everything you need for food, water, shelter (or otherwise survive the elements), and medical necessities. It’s not about comfort. It’s not about living your best diabetic life on the road with all the spoils you’re accustomed to. It can’t just be a bag full of diabetes supplies, but rather only the most critical of them.

Because we live in the Colorado mountains, our BOB includes a Jerven Bag (multi-purpose shelter/poncho/sleeping bag with incredible thermal properties) and at the very center of that mass, I’ve buried 2 vials of insulin. It’s the only perishable item, and I’ve done the most I can to protect it. (Remember insulin is way more susceptible to cold than heat.) 2 vials is way more than I should ever need in 3-4 days, but that provides a backup if one breaks and accounts for the fact that old, denatured insulin still works, just not as effectively, so I might need a lot more of it. Elsewhere in the backpack, I have 1 pack of 10 insulin syringes, an unopened vial or urinalysis strips, and 1/2 lb of dextrose that has been vaccum sealed in a re-sealable mylar pack. I need insulin, I’ll die without it, simple fact. Syringes are the simplest, no-frills way to deliver it. Syringes don’t expire, can be re-used, don’t require electricity, and can’t malfunction. Urinalysis strips are absolutely rudimentary, but last practically forever if they’re sealed from humidity and offer the bare minimum I need to know without depending on batteries or electronic devices. Thankfully, I’m still hypo aware, but a glucometer would make the ranks if I weren’t. And that pure dextrose provides more than 225 grams of fast acting carbs which can be consumed in a variety of different ways, even dissolved in my saliva and absorbed through my mouth if I’m unresponsive. It’s intentionally a lot of carbs, because it’s also backup energy reserve if we need to hike to safety.

Now, because I’m spoiled rotten in my diabetes care, there are other diabetes amenities in the car, but they’re not part of my BOB. I’ve got a bag that lives in the house but goes wherever I do with a spare Omnipod (infusion set and cartridge previously), spare Dexcom, my active vial of insulin, 1 juice box, a few rolls of smarties, a handful of alcohol wipes, 2 insulin syringes (in case my pump or controlling device fails), and a rechargeable battery pack. Coincidentally, it’s also how I rotate my supplies. When I need to change a pod or Dexcom, I use the oldest one from that kit, and replace them before returning it to the shelf. I’ve also got a glucometer and ANCIENT expired glucagon kit that just live in the door pocket of the car. Like I said, though, none of these things are part of the BOB. Those are additional comforts I enjoy having the security of. If I were in an emergency situation where I needed to abandon the car and travel lightly, though, they’re not coming with me. Just the compact, portable essentials in the BOB.

All those other things listed are great elements of a Shelter In Place plan and Evacuation Kit. Essentially everything you need for 30 days, not just 3-4. Those are meant to be a little more robust and inclusive.
And guess what… Those 2 things are nearly identical, because large scale evacuations are a slow process. These kinds of massive events we can usually see coming for days before… if not weeks or even months. If you know a hurricane, wildfire, or some other tragedy is coming your way, then you should be relocating your SIP kit to the car, where it is now everything you need to evacuate. IN ADDITION TO YOUR BOB, WHICH IS ALREADY LIVING IN THE CAR.

I gotta laugh about this one, though:

@Jay6

Stain removal pen(s) to remove blood stains from bleeders, etc.

In what type of emergency situation do we care about aesthetics?

[Marilyn6]

We live part of the time on the Oregon coast, where we are always aware that we could have a huge earthquake and tsunami. We have neighborhood survival meetings. My husband and I always keep a go bag in the car and one in the house. We have a storage of food, water, insulin and try to have a months supply of prescription medicines

I have heard that we could be isolated for 3 weeks to 5 yrs. If we aren’t injured we should be able to survive for the 3 weeks especially if we can camp at home. At our ages 71 and 73 we figure that longer than that might not be doable. I have lots of insulin, but whether I can keep it safe from the elements is a big question.
We figure that if we are able to live through the earthquake unharmed then we have a chance at survival.

We also live in the woods in Idaho where a forest fire is always possible. We have go bags there too. We also have canned goods and water just in case of some kind of problem.

[Marilyn6]

We also keep our car’s gas tank full.

[Jay6]

thank all of you for you kind comments:

Reference: " PROTOCOLS for managing pump, sites, hypoglycemia, and hyperglycemia - including on & off pump instructions and supplies." The initial list of items was take from the “items to have” on several pump manufacture’s lists including Tandem, the defunct Animas, Medtronic, etc. It is our responsibility to have a pump failure plan available at all times.
Reference: “Diabetes medical alert identification or jewelry (should be wearing/carrying)” the items from Medic Alert Foundation are great. Yes, EMS is taught to scan the QRC on the cards or IDs.

Reference: “maintain a second “off warranty “ pump” for emergencies has been run around and around until the fur has been beaten off of the dog. It is a workable idea IF & ONLY IF, the pump settings are current. Otherwise, resorting to MDI may be safer. The status of pump settings is one reason Tandem gives for not having a ‘programming’ option in tConnect to program an in warranty pump exchange - - the settings in the server may not be current and could be harmful. Lawyers got this one.

Reference: “according to the latest NHC timeline, the eye of the storm” is the main reason this was put up. There have been 1000 year floods near me in Eastern Kentucky, hellacious wildfires in the western USA, to name a few. The time was right.
A hard copy of the Medic Alert EMI page in the package would be grand. Technology fails.

@John58
REFERENCE: “A list of current medications (both brand & generic names) including dose and when taken. Your pharmacist can help with this and possibly provide a document to get medications filled away from home in an emergency.” The comment was made to have current paper prescriptions. The practice of printed prescriptions handed to the patient or filled by local pharmacies is drawing to a close according to most sources. There have even been documented social media posts of insulin pumpers asking for ‘backup scripts’ being told the state (later verified) does not allow them & instead mandates E-Scripts, etc.

@Marilyn6 , How many days? The 30 day inventory came from a FEMA Shelter manager and was agreed to by consensus of the responding health care professionals.

@Robyn_H , you are not alone. Stain pen came from EMS in KSA.
Some commenters in multiple sites across the social media world have discussed the various names for the kit.
The names for the bag have come from a myriad of sources and are for all intents and purposes deemed to be interchangeable and semantically equal. The names originated with the following classes of contributorsd:
Insulin pump manufacturers
Endocrinologists (USA, Australia, European Union, UK, KSA, Egypt, & Canada)
Diabetes Educators, Physician Assistants, & Nurse Practioners
Paramedics & EMS responders (USA, European Union, UK, KSA, Canada)
Red Cross & USA FEMA evacuation shelter managers

With the input of the above, the following are seen identical, interchangeable and semantically equal.

Insulin Pump Emergency Kit, Go-Bag, or BOB - Bug Out Bag

It is my hope all can be tolerant of this endeavor to help and not confuse or initiate word wars.

Here is a working idea for the BOB.

[Laura_S]

One year I actually had to argue with Gentiva Medical supply because they said no diabetic needed any spare infusion sets. One or two times I had to deal with a nosy pharmacist who said no one needs spare medications,especially insulin and pump supplies, plus syringes.
Now, I get as many things as the insurance will let me, and I have a spare supply closet. It’s not in a bag and though we are in a relatively storm free area, you never know. The economy can crash too so… Something to think about and prepare for!

[Luis3]

@Laura_S

I have a spare supply closet

OOOO! A “D” closet. I only have “D” drawers. I do have a Go-Bag with some essentials minus insulin (that’s in the fridge). It has syringes, infusion sets, G6 sensors and one transmitter, glucometer, syringes and alcohol wipes. Every time I get new supplies I rotate stuff in and out.

I have a pencil case that has a glucometer, lancet device, a syringe for drawing insulin out of a pump cartridge in even of a failure, Glucose tablets, a nut bar and peanut butter crackers that goes with me whenever I leave the house. I originally came up with it to fit in my cycling jersey back pocket.

[Jay6]

Thank you for sharing . The list started as a pump project. Now, as in your clinical picture, it serves as an idea to encourage thinking & preparation.

Disasters & evacuations are unique.

The idea of adding your son to your bank accounts brings another idea to light. If you don’t want your son accessing certain accounts, the “TRANSFER OF DEATH” or TOD is commonly used. I mention it for other readers thinking in a common light.

| Marilyn6
September 24 |

• | - |

Jay, I have enough long and short acting insulin to last indefinitely, and I have several sensors and a couple of transmitters. I don’t use a pump, and have never tested for ketones. I also have test strips etc. The problem for us will be carrying all all of this if we can’t use our car or house. We bought emergency rations, water, sleeping bags, blankets and all kinds of emergency equipment. We will be ok if we can use our car or house, but there will be no way to walk out if there is a massive earthquake.

We have also put our son’s name on bank accounts in case our bodies can’t be found.

[meee]

Sounds good, I don’t think I can do that to have in hand, but I would throw what I need together in advance once an emergency has been declared. I don’t think stain remover pens are needed in an emergency though. And they don’t work for me anyway in the past, so maybe hydrogen peroxide which is also a disinfectant.

[Timothy]

In 1994 I was taking ultra lente and humalog which was pretty new. No cgm at the time and I kept a bag with all my stuff ready for emergencies.

there was a major earthquake centered right we’re I lived in Northridge California.
The lights were all out and emergency lights were not working either.
I felt my way outside. My car had been flattened by the apartment falling but none in my building was killed.

My emergency earthquake kit was in my car not retrievable and after I left my apartment, the police wouldn’t let me back in.

So I walked to a pharmacy 2 miles away and they gave me insulin and syringes on my word because I had no way to pay and there was no power and they couldn’t look up my scripts.

But then I went to my bank and withdrew 100$ also with my signature that no one could verify.

Life was different back then for sure.

So what I’m saying is, no matter what your plan is, expect you will need a secondary plan.