The power is out and an elderly parent is at home. What do you do first?

First: the mains-powered equipment stop-check

Walk the house and answer one question about each of these. Not "roughly" — yes or no, for each:

• Oxygen concentrator. It runs on mains power, delivers continuously, and has no stored reserve. A concentrator household is on bottled oxygen or on the move; there is no third option.
• Home dialysis. A mains-powered machine with a water supply requirement and a schedule that does not negotiate.
• Infusion pump. Battery for hours, not days.
• CPAP or BiPAP. Battery for a night or two at best — and the person who cannot use it does not sleep, which degrades everything else in the plan within 48 hours.
• Powered wheelchair or scooter. The mobility plan depends on the charge, so the chair is charged whenever the power is on, always, without discussion.

The device list and what each one means during an outage: Document 06, §6.2.1.

When to call for help rather than manage it at home

The program does not print a triage algorithm, because it cannot source one. What it prints are red flags that are first-aid rules rather than clinical judgements, and for this household the ones that matter are:

• A device that has stopped and has no alternative power. Call the supplier's emergency number and the household's clinical contact, and start the move.
• A medicine that must stay cold with no cold storage left, or a prescription running out with no route to a refill. The clinical risk is now the outage's fault, and rationing does not solve it (Document 01, §1.9.1).
• Heat stroke signs — body temperature above 103 °F, confusion, slurred speech, loss of consciousness. Call the emergency number now, and do not give fluids to a suspected heat-stroke casualty; a confused or unconscious person aspirates (Document 05, §5.9.1).
• Diarrhoea or vomiting in an elder that will not stop, or blood in it. Rehydration sachets are first aid, not treatment (Document 01, §1.9.1).
• A fall the adults present cannot safely manage. Falls are the leading injury cause over 65, and an unsafe lift is how a fall becomes a permanent injury (Document 01, §1.9.5; Document 05, §5.6).
• A new confusion in an older person on multiple medicines. That is a medical event, not a bad night — and only a clinician can tell an infection from dehydration, heat or a drug interaction (Document 06, §6.2.4).

Heat: the fan rule, and the one thing to stop doing

Both CDC and the National Weather Service state it plainly: use fans only if indoor temperatures are less than 90 °F, because above 90 °F a fan can increase body temperature (Document 04, §4.3.1). A fan cools by moving air across sweating skin; once the air is hotter than the skin, moving more of it adds heat faster than evaporation removes it. The household most likely to be harmed is the one that leaves a fan pointed at a sleeping elder all afternoon on the worst day.

Above 90 °F indoors, the alternatives are cheaper than a fan and they work: close windows and shades on the sun side by day and open them at night; wet the skin rather than blowing air at it — a cool damp cloth on neck, wrists and forehead, a tepid sponge, feet in a basin; cut heat production indoors; move down and to the north side of the building and sleep there; and use a cooling centre in the afternoon, which is not defeat but the correct use of a building you do not control. Dial 2-1-1 for the nearest one before you need it (Document 04, §4.3.1 and §4.3.4).

And look at the elder rather than asking. "Are you too hot?" gets "I'm fine" from someone whose judgement the heat is degrading. Look for flushed, confused, not sweating when everyone else is, or unusually quiet (Document 04, §4.3.3).

Cold: behaviour changes before the thermometer does

No core-temperature threshold is printed in the book for cold, because the verified clinical material it could retrieve covers heat illness rather than cold injury. What it prints instead is the rule that matters in a flat:

Hypothermia is a behaviour change before it is a temperature: slurred speech, clumsiness, confusion, withdrawal — and the person who has stopped shivering, which is worse, not better. Handle a severely cold person gently, because rough movement can disturb the heart rhythm. No rubbing, no hot water, no alcohol, no cigarettes; warm the trunk first (Document 05, §5.9.2).

One more rule that catches whole households: if two or more people in the same room are drowsy and confused at once, treat it as carbon monoxide until the alarm says otherwise. Everyone outside, then call from outside (Document 04, §4.2.4).

Medicine that has to stay cold

This is where the honest answer is uncomfortable, so it is worth stating plainly: the book prints no "your medicine is good for X hours at Y degrees" figure. It is product-specific, the label carries it, and your prescriber's or pharmacist's answer is the one that counts (Document 06, §6.2.3). What you can do without any figure at all:

• Keep the fridge shut. The same four-hour discipline that protects the food protects the medicine, and every door opening shortens both clocks.
• A thermometer in the fridge turns a guess into a reading — the only way to know what happened while the doors were shut.
• Move the medicine out only when the plan says so — a cooler with ice packs, or the provider's stated alternative — and never freeze it. A fridge that stops in winter, or a cooler with too much ice, can freeze a liquid medicine, and a frozen medicine is a spoiled medicine.
• Label the cooler, and label the ice. A cooler that also holds food is a cooler that gets opened.
• Write down the time the power went off. That single fact is what every later conversation needs — with the provider, the pharmacist, the supplier and the emergency department.

Two rules that do not bend. Nothing is stopped, halved or skipped because the supply looks short — CDC's wording is unambiguous: "Don't stop or change your medicines until you talk to your doctor." Stretching a cardiac or seizure medication to make it last is the most common way a supply problem becomes a death, and it is done with the best intentions by the most careful person in the house. And some medicines make a person more prone to dehydration or overheating, and some need to be kept out of hot places, so in a heat wave the medicine box moves to the coolest room (Document 06, §6.2.4).

Three calls to make before the outage, not during it

The provider: "If the power is out for three days, what do I do about this medicine and this device?" Ask for the answer in writing. The pharmacy: "Can I have a refill a week early so I am never below a few days' supply?" Ask about your state's emergency-refill rules, and ask what the pharmacy does when its own power is out. The equipment supplier: for an oxygen concentrator or a dialysis machine the supplier — not the household — knows the backup plan, the loaner policy and the priority-restoration route. Get their emergency number written on the household's emergency contact card, and ask whether your address is on a medical-device registry; do not assume a utility or a city knows a device is in the house (Document 06, §6.2.2).

Why "we'll just wait it out" fails for this household

Waiting is a plan for a household whose risks arrive slowly. In a household with an older adult, they do not. The device risk arrives in the first hour. The cold-medicine risk arrives within the first day. The heat risk arrives on the first hot afternoon, and it degrades the person's own judgement, so the person it is happening to is the last one who can report it. Dehydration in the very old is fast, and it is the commonest serious complication of a water outage (Document 01, §1.9.1).

That is why the program's answer to this household is not a bigger gear list. It is a written trigger — a sentence agreed in advance that says at what point this household moves rather than copes — plus the phone numbers and the destination already settled, so the decision is not being made by frightened people at three in the morning (Document 01, §1.9.6; Document 08).

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