Carbon Monoxide

CO is called the "silent killer" because it is a colorless, odorless, tasteless, non-irritating gas. If the early signs of CO poisoning are ignored, a person could lose consciousness and be unable to escape danger. More people die from CO poisoning than any other kind of poisoning.

Where does Carbon Monoxide (CO) come from?

• Any fuel-burning appliance that is malfunctioning or improperly installed.
• Furnaces, gas range/stove, gas clothes dryer, water heater, portable fuel-burning space heaters fireplaces, generators and wood burning stoves.
• Vehicles, generators and other combustion engines running in an attached garage
• Blocked chimney or flue.
• Cracked or loose furnace exchanger.
• Back drafting and changes in air pressure.
• Operating a grill in an enclosed space.

Symptoms may include:

• headaches
• dizziness
• nausea and weakness
• loss of muscle control
• shortness of breath
• chest tightness
• visual changes
• sleepiness
• fluttering of the heart
• redness of the skin
• confusion

At high levels or continued exposure, CO can cause loss of consciousness, brain damage or death.

Early symptoms of CO poisoning are similar to the flu.

With CO poisoning, symptoms may occur or get worse when you turn on the fuel-burning device. Also, more than one person in the house gets sick at the same time, unlike flu that takes time to pass from person to person. Lastly, symptoms are worse in a certain location but them get better when you leave that area.

If you suspect CO poisoning:

• Open all windows and doors.
• Get outside immediately to get fresh air.
• Call 911 if you suspect that you or someone else has CO poisoning.
• Contact the fire department and gas company from outside the building.

Are some people more sensitive to the effects of CO? Yes. Even low levels of CO can be a concern for the elderly, infants, the unborn, those with anemia, or those with heart or breathing problems.

During a power outage be careful about the use of these appliances as they can cause a buildup of toxic CO gas.

• Never use a gas range or oven for warmth.
• Never use a charcoal grill or barbecue grill in your home or garage.
• Never run generators in indoor spaces, such as garages, basements, porches, crawlspaces or sheds, or in partly enclosed spaces such as carports or breezeways. Generators should only be operated outside, far away from (25 feet or more if possible) and downwind of buildings.
• Never use a stove or fireplace unless it is properly installed and vented.
• Never start up or run any gasoline-powered engines (mowers, weed trimmers, snow blowers, chain saws, generators, or other small motors) in enclosed spaces.
• Never leave your car idling in a closed garage or use fuel-powered appliances or tools in
  enclosed, attached areas such as garages or porches. Carbon monoxide can seep into your
  home through vents and doors.

Carbon Monoxide Detectors

• Every home with at least one fuel-burning appliance/heater, attached garage or fireplace should have a CO alarm.
• If the home has only one CO alarm, it should be installed in the main bedroom or in the hall- way outside of the sleeping area.
• An alarm should be installed on every level of the home and in sleeping areas.
• Place the alarm at least 15 feet away from fuel-burning appliances.
• Make sure nothing is covering or obstructing the unit.
• Do not place the unit in dead air sp
• Every month, unplug the unit and vacuum with a soft-brush attachment or wipe with a clean, dry cloth to remove accumulated dust.
• aces or next to a window or door.
• Test the CO alarm once a month by pressing the test/reset button.
• Don't let having a CO detector lull you into a false sense of security. Preventing the problem is better than relying on an alarm.

Additional Information

• Carbon Monoxide Virtual Toolbox
  provided by the Office of Fire Prevention and Control
• Carbon Monoxide Frequently Asked Questions
  Facts and answers to the common questions on carbon monoxide.
• Carbon Monoxide Tri-Fold Brochure
  A printable tri-fold brochure that details where carbon monoxide come from, what it does, and the do's and don'ts to make one's home safer.

Disinfecting Drinking Water Wells

Flooded Well

If the area around your well was flooded (including by sea or brackish water), ASSESS, FLUSH FLOODWATERS FROM THE WELL, REPAIR, DISINFECT, then FLUSH the well again. The water should be tested to determine whether it is safe for drinking. If, after following these steps, the well water tastes salty or has a chemical or gas/oil taste or appearance or if you still have concerns, contact your local health department (LHD) or a New York State Department of Environmental Conservation (DEC) registered well driller (contact your local DEC Region office for registered well driller information).

Test Well Water

Before you test the water, make sure:

• All flood waters around the well have drained and the well area has been cleaned up.
• Any needed repairs have been completed. Some damage may need to be repaired by a qualified professional.
• The well is in good condition and operable.
• All flood water has been flushed from the well, and the well and all household plumbing has been properly disinfected. Flushed well water needs to be discharged as far away as possible from the well so as not to recycle back into the well. For more information on flushing and discharges contact your Local Health Department.
• After disinfection, the well has been flushed to remove chlorinated water. Wait seven to ten days to make sure that all chlorine is out of the system. Flushed water needs to be discharged as far away as possible from the well so as not to recycle back into the well. For more information on flushing and discharges contact your Local Health Department.

After you have made any needed repairs and disinfected the well, your water is ready to be tested. Until testing shows that the water is free of contamination, continue to use bottled or boiled water for drinking and food preparation.

What should the water be tested for?

The water should be tested for total coliform bacteria. Total coliform counts give a general indication of the sanitary condition of a water supply. If total coliform are present, the laboratory follows-up with a test for E-coli. E-coli indicates that there is contamination from sewage or other source of feces. If you suspect other contaminants (such as oil, pesticides or fertilizers), testing for these may also be needed. Contact your local health department for advice. You can find that number in the blue pages of your phone book, or at http://www.nyhealth.gov/environmental/water/drinking/doh_pub_contacts_map.htm

Who should do the water testing?

A laboratory approved to test potable (drinking) water in New York State should do the test. A list of these laboratories can be found at http://www.wadsworth.org/labcert/elap/comm.html.

How should I collect a water sample to have my well water tested?

Contact a certified laboratory of your choice http://www.wadsworth.org/labcert/elap/comm.html to get a certified sample bottle and sampling instructions. Follow sampling instructions provided by the laboratory.

If you did not receive instructions from the laboratory, do the following:

• The bottle you got from the lab is sterile.
  • Do not open the bottle until you are ready to fill it.
  • Do not rinse the contents from bottle.
  • Do not touch the inside of the bottle or the bottle cap with your fingers.
• Before taking the sample:
  • Use a faucet that has separate hot and cold water handles or that can be adjusted to provide just cold water.
  • If the faucet tip has a wire screen aerators, remove it and any rubber gaskets from the faucet.
  • Disinfect the faucet tip with chlorine bleach (use bleach cap to bring bleach to the faucet tip); or by "flaming" the faucet tip with a lighter or match for 10 seconds (be sure to remove rubber faucet seals first).
• To take the sample:
  • Let the cold water run for 4 - 5 minutes.
  • Fill the bottle with cold water to the indicated fill line and cap it tightly.
  • Close the bottle immediately once it is filled with water from your tap.

For other types of contamination (such as oil, fertilizer or pesticides) a professional may need to collect the sample. Contact the laboratory to check on this.

What should I do with the sample?

Fill out the sample label and form provided by the lab. Place the bottle in a clean cooler or other container with ice in a sealed plastic bag or with blue ice to keep the sample chilled. Deliver or ship the sample to your chosen laboratory within the time period specified by the laboratory.

How much does it cost to test the water for total coliform bacteria?

Cost for the test varies with laboratories, but a test for total coliform bacteria typically costs $20 to $40.

I received the test result from my water sample. What does it mean?

If the lab report says:

• "negative, absence or A" for total coliform or E-coli bacteria - the water is free of coliform or E-coli bacteria.
• "positive, presence or P" for total coliform and E-coli bacteria - the water is contaminated with coliform and E-coli bacteria.

If you have questions on interpreting the test results, or the lab report will note if other contaminants tested for are present, contact your local health department. http://www.nyhealth.gov/environmental/water/drinking/doh_pub_contacts_map.htm

What should I do if the water is still contaminated with bacteria after disinfecting and testing has been completed?

Contact your local health department for advice. You can find that number at http://www.nyhealth.gov/environmental/water/drinking/doh_pub_contacts_map.htm

How do I disinfect my drinking water well?

You can make your household water ready to use again by disinfecting your well and household plumbing with diluted bleach, and then flushing it.

If you have internet access, you can get the directions on how to do this on page 16 of the document found at: http://www.nyhealth.gov/publications/7064.pdf or call 518-402-7650.

If you do not have internet access, you can all the NYS Department of Health at 518-402-7650 or follow these 12 steps:

YOU WILL NEED:

• 1 gallon of household bleach (unscented)
• A 5 gallon bucket
• Garden hose long enough to reach the well from the house
• Make sure the electricity is on and that the pump is receiving power

PROCEDURE:

1. Attach the hose to the outdoor faucet closest to the well or directly to the pressure tank faucet. If possible, bypass any water treatment equipment, such as a water softener to prevent damaging or clogging it.
2. Turn on the faucet to run water outside on the ground away from the well until the water is clear.
3. Next to the well casing, mix one (1) gallon of household bleach and enough water to fill the 5 gallon bucket or pail to dilute the bleach.
4. Turn off the faucet and turn off electrical power to the well pump.
5. Carefully remove the well cap and set aside. Place the hose inside the well casing and turn the electrical power back on and turn the faucet back on to run water into the well.
6. Carefully pour the water and bleach mixture from the bucket or pail down the open well casing while continuing to run the water from the hose into the well to recirculate the bleach and water mixture. Use the hose to also wash down the inside of the well casing and well cap.
7. After one hour, go to each indoor and outdoor faucet and run the water until a chlorine odor is present, then shut each faucet off including the faucet going to the well.
8. Turn off the power supply to pump. Remove hose from well and replace the well cap.
9. Allow the well and plumbing to stand idle for at least 8 hours but preferably 12 to 24 hours with the bleach solution in it. Avoid using the water during this time.
10. After the well has been idle for the recommended period of time, flush the bleach and water combination out of the well by turning the pump power back on and running the outdoor faucet and garden hose in an area away from grass and shrubbery until the odor of chlorine bleach disappears.
11. Run all indoor and outdoor faucets until the odor and taste of chlorine bleach disappears.
12. After the well has been properly disinfected and the chlorine bleach has been flushed out of the water system, the water should be tested. See the list below of laboratories that are certified to test drinking water. Until testing shows that the water is free of contamination, you should continue to use bottled water or disinfect the water for drinking and food preparation (by bringing the water to a full rolling boil for 1 minute before using).

Labs Certified to Test Drinking Water

Where can I get my drinking water tested to make sure it is safe to drink?

To get the latest list of commercial labs certified to test drinking water in New York State, please check http://www.wadsworth.org/labcert/elap/comm.html

Boil Water Notices

Is my drinking water under a boil water notice?

Response for private wells - If your home gets its water from a private, individual well, then the boil water notices that are issued by public water systems do not apply to you. But this does not necessarily mean that your water is safe to drink. If your well was covered or even just surrounded by flood water, then there is a very good chance that your water is contaminated by waterborne germs. Disinfect your well and get the water tested.

Response for public water service - To know for sure you need to know which public water system serves your residence. You can find this out by looking for the phone number on your water bill, or calling the local town or village. If you do not have internet service, there are some places that you can call to find out. The first place would be your drinking water supplier. Their phone number is normally printed on your water bills. You can also call the local health department office that oversees your drinking water supplier. You can find local health department information at http://www.nyhealth.gov/environmental/water/drinking/doh_pub_contacts_map.htm

What is the difference between a boil water notice, a do not drink notice and a do not use notice?

• A boil water notice is issued for a public water supply when it is possible that drinking water has been contaminated by germs or pathogens that could cause illness. In such cases, you can kill these organisms by boiling your water for a full minute. You should use boiled or bottled water for drinking and cooking. You may also hear this referred to as a boil water order or advisory.
• If your community issues a do not drink notice, that means the water has probably been contaminated by chemicals, and you should not drink it at all. You can flush toilets, but for drinking and cooking use an alternate water source, such as bottled water. Boiling water does not eliminate chemicals and can actually increase exposure to those chemicals.
• If your community issues a do not use notice, that means you should not use the water for any purpose, including flushing toilets and bathing. Do not use advisories are rare, and may be issued when water contact with the skin, lungs, or eyes can be dangerous.

Make sure you understand and follow the instructions with any kind of drinking water notice in your area, and keep listening for updates from your local officials. For more detailed information on how to protect yourself and your family, see http://www.health.ny.gov/environmental/water/drinking/boilwater/

How do I protect my family when my water needs to be boiled?

Basically, just bring water to a FULL ROLLING BOIL for 1 MINUTE. There is no need to boil it longer. Then allow the water to COOL BEFORE USE. Because water may take a while to cool, plan ahead. Make up a batch of boiled water in advance so you will not be tempted to use it hot and risk scalds or burns. You need to think about all the other ways that you use water, and all the ways that water can get into peoples bodies. There is a lot of information available to help you meet your needs to drink, cook, bathe, make infant formula, wash, feed your pets, and all the other uses we have for our drinking water. If you have internet service, we recommend you visit http://www.nyhealth.gov/environmental/water/drinking/boilwater/

Where can I get more information about boil water notices?

For basic boil water facts see the fact sheet "Basic Information for All Consumers". Detailed information for other consumers, such as food service establishments, is available from the NYS Department of Health or your local Health Department. If a "Do Not Use" notice is issued, additional precautions will be needed, contact your water supplier or local health department for guidance.

Can I use my water for cooking?

If a boil water notice was issued for your drinking water, any water used for food preparation or cooking should be boiled first or be from an acceptable alternate source (bottled water, water from another public water supply, water from a tanker provided by an emergency response agency, and water delivered by a NY State certified bulk water provider).

Bring the water to a full rolling boil for at least one minute before adding the food item, like when you make pasta.

How should I wash fruit and vegetables and make ice?

Fruits, vegetables, and any other foods that will not be cooked should be washed and rinsed with boiled (and then cooled) water or water from an acceptable alternate source. Similarly, ice should be made with either boiled water or water from an acceptable alternate source.

Can I use my water for making baby formula or drinks?

No, not without precautions! Any water used for baby food, formula, or making beverages must be boiled (and then cooled!) or be from an acceptable alternate source.

Is potentially contaminated water safe for washing dishes?

You should not use potentially contaminated water for anything having to do with the preparation or eating of food. Therefore, it is not a good idea to use potentially contaminated water to hand wash dishes. You can:

• Use boiled (then cooled) water, or
• Use water from an alternate source, or
• Use your water, but after washing with dish detergent, rinse for a minute in a mixture of 1 tablespoon of unscented bleach per gallon of water. Allow dishes, cutlery, cups, etc. to completely air dry before use.

You can use your home dishwasher if you know that the hot wash is at least 170 degrees F and includes a full dry cycle. However, most home dishwashers do not reach this temperature. If you are uncertain of the temperature of your dishwasher, wash your dishes by hand using one of the three steps listed above.

Is potentially contaminated water safe for washing clothes?

Yes, it is safe to wash clothes as long as they are completely dried before being worn. However, the stirring up of water and cloudiness that may occur during a boil water event may discolor clothing.

Is potentially contaminated water safe for bathing and shaving?

The water may be used by healthy individuals for showering, bathing, shaving, and washing as long as care is taken not to swallow water and avoid shaving nicks. People with open wounds, cuts, blisters or recent surgical wounds and people who have compromised immune systems, (including those who are getting cancer treatments or have AIDS) or suffer from chronic illness should use boiled water (then cooled) or water from an acceptable alternate source. Children and disabled individuals should be supervised to ensure water is not swallowed. Sponge bathing is advisable, and bathing time should be minimized to further reduce the potential for swallowing.

Can I brush my teeth with the water without boiling it?

No! Any water you swallow or place in your mouth should be disinfected by boiling (and then cooled) or come from an acceptable alternate source.

How should I wash my hands during a boil water notice/order?

Generally, vigorous washing with soap and your tap water is safe for basic personal hygiene. If you are washing your hands to prepare food, you should use boiled (then cooled) water, bottled water, or water from another acceptable source.

Can I use hand sanitizing lotion or wipes?

Hand sanitizing wipes alone are not enough, especially to clean your hands for making food. Alcohol based sanitizers work against some common germs (like E. coli, and Salmonella) but may not be effective for all.

What if I have already consumed potentially contaminated water?

Illness is possible, especially for people that already have a chronic illness or may have compromised immune systems, for example, from AIDS or cancer treatments. This is why boil water notices are issued. Anyone experiencing symptoms such as diarrhea, nausea, vomiting, and abdominal cramps should seek medical attention. These symptoms (with or without fever) are not always due to contaminated water and a doctor's assessment and medical testing are key to identifying the cause of illness.

What should I do when the boil water notice is lifted?

If you are on a private well, the boil water notice does not apply to you. If your public water was on a boil water notice, do the following:

• Flush household pipes/faucets first: run all your cold water faucets on full for at least five minutes each. If your service connection is long or complex (like in an apartment building) consider flushing for a longer period. Your building superintendent or landlord should be able to advise you on longer flushing times.
• Automatic ice makers: dump existing ice and flush by making and discarding three batches of ice cubes. Wipe down the ice bin with a disinfectant. If your water feed line to the machine is longer than 20 feet, increase to five batches.
• Hot water heaters, water coolers, in line filters, and other appliances with direct water connections or water tanks: run enough water to completely replace at least one full volume of all lines and tanks. If your filters are near the end of their life, replace them.
• Water softeners: run through a regeneration cycle.
• Reverse Osmosis (RO) units: replace pre filters, and check owner's manual.
• Replace other water filters, as they are disposable and may be contaminated. This applies especially to carbon filters and others that are near the end of their life.

What is an acceptable alternate source for safe drinking water?

Good alternate water sources include bottled water, water from another public water supply, water from a tanker provided by an emergency response agency, and water delivered by a NY State certified bulk water provider. Roadside springs are not a sure source of safe drinking water.

Prescription Medication Information

What if I have a prescription from a chain pharmacy that is now inaccessible due to the storm?

If a patient has had a prescription filled from a chain pharmacy that is now inaccessible due to the storm, another pharmacy within that chain can likely access the database to verify the authenticity of the prescription, and refill your prescription if refills are remaining. Under the same circumstances, prescriptions for controlled substances may also be refilled.

What if I have a prescription from an independent pharmacy that is now inaccessible due to the storm?

If a patient brings a prescription to a pharmacy without a shared database, such as an independent pharmacy, and can present reasonable evidence (labeled prescription vial, label receipt, etc. from a prescriber or a pharmacy in the affected area) that they were receiving a non-controlled substance from an inaccessible pharmacy, they may be provided with a limited quantity based upon the pharmacist's discretion.

What if I don't have my prescription and I am in need of my maintenance medication?

Pharmacists may use their professional judgment to dispense limited quantities of non-controlled substances to patients who state they are in need of maintenance medications but have NO evidence such as a prescription vial, label or receipt.

What if my primary care physician is unavailable, where should I go to get a new prescription issued?

Patients are advised to go to an urgent care or walk-in center to get new prescriptions issued, if their primary care physician is inaccessible. Patients are also advised not to go to an emergency department unless they have a medical emergency.

Diabetes Medication and Supplies

I have diabetes and had to leave my home without my insulin or diabetes supplies. What can I do to manage my blood glucose?

There are several options to help you manage your blood glucose in an emergency situation.

Medications

• If you have had a prescription filled from a chain pharmacy that is now inaccessible due to the storm, another pharmacy within that chain can likely access the database to verify the prescription, and refill it, if refills are remaining (also true for strips.
• If the pharmacy that holds your prescriptions is open, but you are no longer in that area, you can call and ask the pharmacist to transfer your prescription to another pharmacy for an emergency refill.
• If you bring a prescription to a pharmacy that does not have a shared database, and you can present reasonable evidence (labeled prescription vial, label, receipt, etc. from a prescriber or a pharmacy in the affected area) that you were receiving a prescription medication (non-controlled substances only) from a pharmacy that is now inaccessible, you may be provided with a limited quantity of the medication, at the discretion of the pharmacist.
• If you don't have the medicines you need and are unable to reach your primary care physician, check with an urgent care or walk-in center. They may be able to provide you with new prescription(s). Only go to an emergency department if you have a medical emergency.
• Medicaid and many commercial health insurers are waiving refill time limits, so early refills may be feasible.
• In addition, pharmacists may use their professional judgment to dispense limited quantities of non-controlled substances to patients who state they are in need of maintenance medications but have NO evidence such as a prescription vial, label or receipt.
• If the above options are not possible, in emergency conditions, you may be able to use insulin that is available without a prescription on a temporary basis. These insulins include Humulin R, Novolin R, Humulin N and Novolin N. Switching insulin should always be done in consultation with a physician and requires close medical supervision. Make sure to closely monitor your blood glucose and seek medical attention as soon as possible. Information that may be helpful for switching insulins is outlined below.

Short acting and rapid acting insulins

• One brand of regular insulin (e.g., Humulin R and Novolin R) may be substituted for another brand of regular insulin. Regular insulin may also be substituted for rapid-acting insulins (e.g., Humalog and NovoLog) on a unit-per-unit basis, but it will have a slower onset of action and it will last longer than the rapid acting insulin.

Intermediate and long acting insulins

• One intermediate-acting insulin product (e.g., Humulin N, Novolin N) may be substituted for another intermediate-acting insulin product on a unit-per-unit basis. Likewise, these insulins may also be substituted for long-acting insulins (such as Lantus or Levemir) on a unit-per-unit basis or vice versa.

Insulin Mixes

If using pre-mixed insulin products (e.g., Humulin 70/30, Humalog mix 75/25, Novolin 70/30, NovoLog Mix 70/30):

• One insulin mix product may be substituted for another on a unit-per-unit basis.
• If no other insulin mix is available, you should first substitute an intermediate insulin on a unit-per-unit basis relative to the intermediate-acting component of the mix (e.g., in the examples above, approximately ¾ of the total unit dose of the mix).
• If regular or rapid-acting insulins are also available, they may be used before major meals along with the intermediate- or long-acting insulin (dosed as above) in doses equivalent to approximately ¼ of the total dose of pre-mixed insulin usually taken before that meal.

Insulin Pumps

• People using insulin pumps who must switch to injected insulin may substitute an intermediate- or long-acting insulin for the 24 hour total daily basal dose of infused insulin on a unit-per-unit basis, always making sure that the total dose of intermediate acting insulin such as NPH is split between morning and evening doses.
• If regular or rapid acting insulin is also available, people should administer mealtime insulin according to their previous system for calculating their bolus insulin doses. Long acting insulin can usually be given once a day as a basal insulin.

Insulin storage

• Don't be concerned if you have insulin that hasn't been refrigerated. Insulin may be left unrefrigerated for up to 28 days and still maintain its strength. Avoid storing insulin at extreme temperatures. Avoid freezing or heating.
• More information regarding insulin storage and switching insulin in an emergency can be found at http://www.fda.gov/Drugs/EmergencyPreparedness/ucm085213.htm .

Diabetes Supplies

• In NYS, many pharmacies, practitioners, and health care facilities have been certified by the NYS Department of Health to sell or furnish new, sterile syringes through the Expanded Syringe Access Program (ESAP). To find and ESAP provider in your area, go to this website, or :
• They are listed by county and sorted in zip code order. This information is also available via telephone through the NYS AIDS Institute at the following numbers:
• English 1-800-541-AIDS
• Spanish 1-800-233-SIDA
• Deaf/TDD 1-800-369-AIDS
• Although diabetes test strips may be purchased without a prescription, check with your health plan to see if they normally require an order. Diabetes test strips are e stable, even at extreme temperatures, as long as they remain dry.
• If you use a blood glucose meter, check the meter and test strip package insert for information on use during unusual heat and humidity. Store and handle the meter and test strips according to the instructions. If you do not have access to your meter, many pharmacies have low cost meters available. A small supply of lancets is usually included with new glucose meters.

Diabetes Emergency Care Tips

• Keep a source of quick acting carbohydrate (e.g., glucose tablets, orange juice, etc.) available in case of a low blood glucose.
• Be aware that stress can cause a rise in your blood glucose and that erratic mealtimes can cause changes in your blood glucose.
• Recognize that excessive work to repair damage caused by the disaster (without stopping for snacks) can lower your blood glucose.
• Wear protective clothing and sturdy shoes.
• Check your feet daily for irritation, infection, open sores or blisters. Disaster debris can increase your risk for injury. Heat, cold, excessive dampness and inability to change footwear can lead to infection, especially if your blood glucose is high. Never go without shoes.

What to do with Food in Your Home After a Flood

Flood waters and sediment can contain microorganisms such as bacteria, viruses and parasites, and sometimes chemical contaminants. If flood waters contact food items, the food can become contaminated. Also, if the flood caused the power to go out, perishable foods in the refrigerator and freezer may become spoiled, even if they were not contacted by flood waters.

What should I do with foods that came into contact with flood water?

Nearly all foods that were contacted by flood water should be discarded. Foods that are specifically recommended to throw away include fresh fruits, vegetables, meat, cheese, dried goods and other pantry items. If in doubt, throw it out!

In addition:

• Discard food containers with lids that are screwed on or pressed on (such as condiment containers, soda and beer bottles).
• Discard home canned goods with screw tops and seals (such as pickles and jams).

Are there any foods that can be used following contact with flood waters?

Commercially processed canned goods can be used unless the cans are swollen, rusted, seriously dented, or the contents cannot be identified. However, the cans should be made usable by the following process:

• Remove labels thoroughly;
• Wash cans with dish detergent and water to remove any flood related residue;
• Disinfect cans with solution of about ¼ cup unscented household bleach per one gallon water;
• Air dry cleaned cans;
• Re-label cans with a marker or new label, including the expiration date.

Refrigerated Foods

Generally, if the power goes out, food in the refrigerator will remain cold for four to six hours if the door is not opened. The temperature in the refrigerator should be at 40 degrees Fahrenheit or lower to keep food from spoiling. If the temperature in the refrigerator was above 40 degrees for more than two hours, many foods will need to be discarded. Foods that should be discarded include:

• Raw or cooked meat, poultry and seafood;
• Casseroles, stews and soups;
• Milk, cream, yogurt and soft cheese;
• Mayonnaise and creamy salad dressings;
• Fresh eggs and egg substitutes; and
• Cream-filled pastries, custard, puddings and gravies.

Some foods people keep in the refrigerator can also be kept at room temperature for a few days. The following foods may be usable, but should be inspected for spoilage before consuming:

• Butter, margarine and hard cheeses;
• Fresh fruits and vegetables;
• Fruit juices;
• Fruit pies;
• Vinegar-based salad dressings, relish, taco sauce, barbeque sauce, mustard, ketchup and olives; and
• Peanut butter and jelly.

Food in Freezers

Generally, if the power goes out, a full freezer will remain frozen for two days, and a half-full freezer for about a day. Foods in the freezer that still contain ice crystals are partially frozen and may be eaten or refrozen. Most foods that have completely thawed, but are still cold and have been kept cold for no longer than one or two days after thawing, may be eaten or refrozen. The following advice should be used to determine what to do with such foods from the freezer:

• Fruits can be eaten if they still smell and taste good;
• Vegetables that have been completely thawed should be discarded;
• Meat and poultry should be discarded if the color or odor is poor or questionable, or if the meat has been warmer than 40 degrees Fahrenheit for two hours;
• Fish and shellfish should not be eaten or refrozen if they have been completely thawed;
• Frozen dinners should be kept refrigerated and cooked as soon as possible; and
• Ice cream should be discarded.

Dishes, Utensils and Cookware

Clean dishes, utensils and cookware with soap and water. Then disinfect dishes, utensils and cookware by soaking them for several minutes in a solution of about one tablespoon of unscented household bleach per one gallon of water. Do NOT use this method on sterling silver tableware. The bleach will cause these items to tarnish. Sanitize sterling silver by putting it in boiling water for at least two minutes.

What if I have more questions about food after a flood?

After flooding, people should follow guidance provided by the New York State Department of Health and other health agencies to protect themselves from biological, chemical, and electrical hazards as they cleanup their properties, homes, and private drinking water wells.

Helpful resources and information can be obtained at: www.nyhealth.gov/environmental/emergency/flood/index.htm or by calling your local health department or the New York State Department of Health at 800-458-1158.

The U.S. Food and Drug Administration also has comprehensive flood related information on their website: http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm064572.htm

Recommended Vaccines

What vaccines do emergency responders need when responding to flooding in New York State?

Tetanus-containing vaccine (e.g. Tdap/Td) is the only vaccine that is needed in this situation. Please be sure to check your immunization history prior to asking for a vaccine, as you may already be protected. You can check to see which vaccines you have received by speaking with your medical provider, workplace employee health service, school, etc.

What vaccines do volunteers helping with disaster response need?

If volunteers are performing clean-up work a tetanus-containing vaccine (e.g. Tdap/Td) is recommended. Please be sure to check your immunization history prior to asking for this vaccine, as you may already be protected. You can check to see which vaccines you have received by speaking with your medical provider, workplace employee health service, school, etc. For children under 19, contact your child's pediatrician.

What vaccines do area residents (including people living in shelters) who are involved in clean-up work need?

Tetanus-containing vaccine (e.g. Tdap/Td) and influenza vaccine. Please be sure to check your immunization history prior to asking for one of these vaccines, as you may already be protected. You can check to see which vaccines you have received by speaking with your medical provider, workplace employee health service, school, etc. For children under 19, contact your child's pediatrician.

Do I need the Hepatitis A vaccine?

There is no indication for the Hepatitis A vaccine given the anticipated conditions in the region and low probability of exposure. No transmission from contaminated water has been identified in the U.S. since the 1980's. Hepatitis A outbreaks have not occurred following other hurricanes or floods in other parts of the country, including the devastating hurricanes in Florida several years ago, Hurricane Katrina, and the Midwestern floods of the late 1990's. New York State has had few hepatitis A cases in recent years. Even though the water and sewage systems are damaged or out of operation in many areas of New York State, the risk of a hepatitis A epidemic is extremely low. Vaccine will take at least one to two weeks to provide substantial immunity.

Are there other vaccines that I should consider getting at this time?

Everyone should check with their medical provider to ensure that they are up to date on their immunizations. No other vaccinations are recommended secondary to the conditions created by the hurricane.

Tetanus

What is tetanus?

Tetanus is a serious infection caused by bacteria that affects the muscles and nerves. It enters the body through breaks in the skin, such as cuts and puncture wounds. Tetanus can be fatal.

Do I need a tetanus Shot?

You can contract tetanus if you are unvaccinated or haven't been vaccinated in a long time and your cut or deep wound becomes contaminated with feces, soil, or saliva. Immediately contact your local health department or see a health care professional who can decide whether you need the tetanus vaccine.

Tetanus containing vaccine is recommended every 10 years. If you have not had vaccine, you should get a Tdap or Td before you go to work in the flooded areas.

Who is At Risk for Developing Tetanus?

Right now, many people are involved in flooding clean up. There is high risk for injury if you are involved in recovery activities. Any cuts and wounds you receive, especially during this difficult clean up time, can be very serious. Don't delay seeking medical attention if you receive a serious cut or deep wound.

What is the difference between the Tdap and Td vaccines?

The Tdap (tetanus, diphtheria and attenuated pertussis vaccine) also contains pertussis or whooping cough vaccine. It is recommended for a single dose for adolescents and adults. Td (tetanus, diphtheria vaccine) does not contain pertussis vaccine.

Where do I get a tetanus vaccine?

You can get a tetanus vaccine from your medical provider or you can check with your local health department to receive one.

I do not know how long it's been since my last tetanus shot, do I need one now?

You can contact your health care provider to check your records but if no information is available you should be protected by getting a tetanus vaccine before you are working in these areas.

Which shot do I need – Tdap or Td?

If you have not had a Tdap vaccine, you should receive a Tdap. If Tdap is not available, you should have a Td vaccine. If you have had a severe allergic reaction to a vaccine containing pertussis in the past you should discuss whether or not you can get a Tdap vaccine with your medical provider.

Tetanus Vaccine Safety

Is it safe for a pregnant woman to get a tetanus shot?

Pregnant women can be protected against tetanus but should consult their health care provider about which vaccine they should have.

Is it safe for breastfeeding women to get a tetanus shot?

Yes, breastfeeding women should be vaccinated as all other adults. If they have not had a Tdap vaccine, they should receive a Tdap. If Tdap is not available, they should have a Td vaccine.

Who should NOT get the tetanus vaccine?

Tetanus vaccine should not be administered to people who have had a severe or anaphylactic reaction to the vaccine. This is very rare and if you are not protected, working on this clean-up effort should be done with caution. The vaccine information sheet (VIS) provides complete information about the vaccine and is available when you get the vaccine.

What are the possible side effects of the tetanus shot?

The most common side effect is experiencing local soreness or tenderness. Using the arm normally and taking a pain reliever can help with the discomfort.

Tetanus Vaccine Administration

How will the shot be administered?

It is given in the upper arm (deltoid) muscle.

How many doses will I need?

One dose is needed. If you have never been vaccinated before discuss whether or not you need additional doses with your health care provider.

Can I get the tetanus shot at the same time as another vaccine?

Yes

Where can I get more information about tetanus and tetanus vaccination?

Contact your provider or local health department. More information is also available at the New York State Department of Health web site or www.immunize.org.

Hepatitis B

Do I need hepatitis B vaccine?

The three-dose hepatitis B vaccine series is recommended for persons who will be performing direct patient care or otherwise expected to have contact with blood or other bodily fluids; if you will be performing these activities you should check your vaccine history before you come to the disaster site. Hepatitis B vaccine is not recommended for persons who will not have contact with human blood or bodily fluids.

I had my hepatitis B vaccine series a long time ago; do I need another shot now?

No. A booster for previously vaccinated persons is not recommended.

I don't know how many doses of hepatitis B vaccine I have had and I lost my vaccine records; do I need another shot now?

If you will be performing direct patient care or otherwise expected to have contact with blood or other bodily fluids, contact your health care provider before you come to the disaster site to determine your vaccine history and need for additional doses. If your vaccine history cannot be verified, consider restarting the hepatitis B vaccine series or limiting yourself to duties which will not involve contact with human bodily fluids.

Where can I get more information on hepatitis B and hepatitis B vaccine?

Contact your health care provider, local health department (see last page), or www.immunize.org.

Influenza/Flu

Do I need the flu vaccine?

All people aged 6 months and older should receive a flu vaccine every year.

I got my flu vaccine last year; do I need another one this year?

Yes. Flu vaccination is recommended every year. Immunity to influenza viruses from the vaccine declines over time and may be too low to provide protection after a year. The flu vaccine protects against three strains of influenza virus. Even if you were vaccinated or had influenza last year you are still susceptible to circulating strains of influenza virus this year.

I had the flu last year; do I need a flu vaccine this year?

Yes. Flu vaccination is recommended every year. Immunity to influenza viruses from the vaccine declines over time and may be too low to provide protection after a year. The flu vaccine protects against three strains of influenza virus. Even if you had influenza last year you are still susceptible to circulating strains of influenza virus.

Is it safe for pregnant women to get influenza vaccine?

Yes. Influenza vaccine is safe for pregnant women and their babies. Pregnant women are recommended to receive influenza vaccine to protect both themselves and their babies against influenza.

Is it safe for breastfeeding women to get influenza vaccine?

Yes.

Where can I get the flu vaccine?

Flu vaccine is available in a variety of settings such as health care provider offices, local health departments, pharmacies, and other private settings, such as certain workplaces. You should check with your own primary care provider first to determine if you can get your vaccine there. Please also keep in mind that not all locations will get the flu vaccine at the same time.

Where can I get more information on influenza and influenza vaccine?

Contact your health care provider, local health department (see below), or www.flu.gov.