A satellite view on Sept. 6 of Hurricane Irma over the Leeward Islands and Puerto Rico. (Courtesy NASA Goddard MODIS Rapid Response Team)

A satellite view on Sept. 6 of Hurricane Irma over the Leeward Islands and Puerto Rico. (Courtesy NASA Goddard MODIS Rapid Response Team)

As Florida patients and residents prepare for Hurricane Irma’s landfall this weekend, they already are employing lessons learned from medical teams and experts who treated victims of Hurricane Harvey’s Category 4 force, after it slammed the Texas coast on August 25. Florida will also face a Category 4 storm impact.

And based on the projected path of this latest storm through Florida’s heavily populated coastline, Irma could cause one of the largest mass evacuations in U.S. history. Meanwhile, two other hurricanes are looming—Jose in the Atlantic Ocean and Katia in the southern Gulf of Mexico.

The impact of natural disasters on cardiovascular disease patients can be unrelenting. Studies of Hurricanes Sandy and Katrina, as well as the magnitude 9 earthquake in Japan in 2011, found an uptick in heart attacks and strokes, and in some studies more deaths from those causes, following the disasters.

Those who are managing heart disease and diabetes—along with their caretakers—are advised to carry with them at least a summary of their medical history along with their evacuation packs, snacks and water. Emergency medicine doctors advise these “go” packs contain medicines, portable medical devices as needed, electronic medical records stored on portable drives, and prescription histories and dosages on USB drives or on paper, all encased in waterproof plastic bags or containers.

[What Katrina can teach us about disrupted cardiac care after Hurricane Harvey]

As with Hurricane Harvey, Irma’s expected large path of destruction and flooding will markedly hinder exits of evacuees. This impacts chain of survival efforts and recovery after cardiac events.

Houston authorities received 60,000 to 70,000 calls for help during Harvey while much of the city was underwater and lifesaving logistics were imperiled. Ambulances and EMS couldn’t quickly access homes, and getting patients to the nearest hospital—let alone the hospital best equipped to treat their particular emergency—was at best a struggle.

“These are all things we normally do routinely,” said Joaquin Cigarroa, M.D., professor of medicine and chief of the OHSU Knight Cardiovascular Institute in Portland. “But they were calling from rooftops. Coupled with the disruption of the infrastructure, there is an expected increase in heart attacks, stroke and sudden death.”

With special caution to those who have had recent procedures, Anand Irimpen, M.D., chief of cardiology at Southeast Louisiana Veterans Health Care System in New Orleans, said: “Patients who have had recent stents are particularly vulnerable for their stent closure if they stop their aspirin and/or Plavix or its equivalent. When these medications are stopped, cardiac patients are prone to heart attacks, particularly in these stressful conditions.”

Eating healthily may also be a challenge in shelter or temporary conditions, added Irimpen, also an associate professor at Tulane University School of Medicine.

[How to prepare for a natural disaster]

During Hurricane Harvey, large mobile pharmacies built inside 18-wheelers rolled into Houston quickly to provide medication to shelter populations and patients.

According to James J. McCarthy, M.D., chair of the department of emergency medicine at the University of Texas Health Science Center at Houston, the city led both large-scale shelter and clinic operations, bolstered by local medical school staffs of the University of Texas and Baylor University and affiliated departments and federal disaster teams.

In order to quickly triage and dispense medications for high blood pressure, diabetes and other conditions, Disaster Medicine Assistance Team squads of 20 to 40 people were deployed in various outposts across the city within 36 to 48 hours, he said.

“The mental health­ burden of a natural disaster is difficult to overstate for patients, for citizens,” McCarthy said, “which is why we had psychiatry [staff] at these shelters as well. We have to make sure it’s not their heart, but anxiety and stress are major components of a medical response like this. They certainly go hand-in-hand with hypertension and the increased risk of all the cardiac events.”

As McCarthy tended to patients at UT Health and coordinated the center’s physician response at area shelters, his fishing buddies took their 16-foot flat-bottom boat and joined other civilian volunteers who ferried residents to safety.

“My fishing partners spent the week rescuing over 100 people from homes,” he said.

As doctors and patients affected by Harvey focus their attention on the storm’s short-term and long-term health consequences, Hurricane Irma, one of the most powerful storms on record, has Florida in its sights.

As of Friday, the entire Florida National Guard, some 7,000 members, will be deployed in the state.