Emergency Preparedness for Medically Complex Kids: What Every Family Should Have Ready

Emergencies are stressful for every family. For families caring for a child with complex medical needs, however, a power outage, severe storm, evacuation, equipment failure, or unexpected trip to the hospital can quickly become a medical emergency.

A child may rely on a ventilator, suction machine, feeding pump, oxygen concentrator, mobility equipment, refrigerated medication, or treatments that must be provided on a strict schedule. Families may also need to bring specialized supplies that are unlikely to be available in a standard emergency shelter or ambulance.

Although no plan can anticipate every situation, preparing in advance can reduce confusion, protect essential routines, and help caregivers make decisions more confidently.

Here is what every family of a medically complex child should consider having ready.

Why Emergency Planning Is Different for Medically Complex Children

General emergency guidance recommends that Canadian households be prepared to manage for at least 72 hours without normal services. For medically complex children, a basic emergency kit is only the starting point. Families must also plan for medical equipment, backup power, medication storage, specialized nutrition, accessibility, transportation, and skilled caregiving.

Possible emergencies include:

• Power outages

• Flooding or severe weather

• Wildfire smoke or evacuation

• Equipment malfunction

• Interruptions to water or heating

• Medication or supply shortages

• A sudden loss of nursing coverage

• An unexpected hospital visit

• A medical emergency involving the child

• A caregiver becoming sick or unavailable

The goal is not to prepare for every possible event individually. It is to create a flexible plan that protects the child's most essential needs when normal routines are disrupted.

1. Create a Written Emergency Care Plan

Every medically complex child should have a concise emergency care plan that another caregiver or healthcare provider can understand quickly.

This is different from a lengthy care binder. In an emergency, the most important information should be available within a few pages.

Include:

• The child's full name and date of birth

• Diagnoses and relevant medical history

• Allergies and previous serious reactions

• The child's usual baseline

• Current medications, doses, routes, and times

• Feeding method and nutrition requirements

• Respiratory supports and usual settings

• Medical devices and equipment

• Mobility, positioning, and transfer needs

• Communication methods

• Emergency procedures and rescue medications

• Signs that the child is becoming unwell

• The child's preferred hospital

• Specialist and pharmacy contact information

• Parent, guardian, and alternate caregiver contacts

• Important treatment limitations or advance care instructions, where applicable

The child's baseline is particularly important. A heart rate, oxygen saturation, breathing pattern, level of alertness, or behaviour that is normal for one child may appear concerning to a healthcare provider who does not know them.

Keep printed copies in the home, emergency bag, vehicle, and child's school or respite setting. Store an electronic copy on caregivers' phones as well.

Review the plan after hospital admissions, medication changes, equipment changes, or significant changes in the child's condition.

2. Prepare a Portable Medical Go-Bag

A medical go-bag should be ready to leave the house at short notice.

Families may need it for an evacuation, emergency department visit, equipment failure, or an unexpected overnight stay.

Depending on the child, it may contain:

• Current medication list

• Essential medications

• Rescue medications

• Copies of prescriptions

• Feeding supplies

• Formula or specialized nutrition

• Syringes and medication adapters

• Feeding tube extensions

• Replacement gastrostomy or jejunostomy supplies

• Suction catheters

• Tracheostomy supplies

• Spare tracheostomy tubes in the prescribed sizes

• Manual resuscitation bag

• Oxygen supplies

• Masks, gloves, and hand sanitizer

• Dressing and wound-care supplies

• Diapers and personal care products

• Chargers, batteries, and power cables

• Communication devices

• Mobility accessories

• Comfort items

• Health card and insurance information

• Custody or consent documents, if relevant

SickKids recommends that families coming to hospital bring current labelled medications, mobility equipment, medical equipment and accessories, specialty formula, chargers, and other items the child depends on.

Label the bag clearly and keep it somewhere all caregivers can access.

Check it regularly for expired medications, depleted batteries, damaged packaging, and supplies that no longer match the child's care plan.

3. Plan for Power Outages

Power loss can be especially dangerous when a child relies on electrically powered medical equipment.

Make a list of every device that requires electricity, including:

• Ventilators

• Oxygen concentrators

• Suction machines

• Feeding pumps

• Airway clearance devices

• Pulse oximeters

• Hospital beds

• Lifts

• Communication devices

• Refrigerators used for medications or formula

• Heating or cooling systems needed for temperature regulation

For each device, determine:

• How long its internal battery lasts

• Whether an external battery is available

• How long it takes to recharge

• Whether it can be powered from a vehicle

• Whether a manual alternative exists

• Which equipment must remain powered continuously

• What the family should do if battery power becomes limited

Families should discuss backup power requirements with the child's medical team and equipment provider. Backup plans may include charged external batteries, a properly installed generator, vehicle-compatible charging, or relocating to a predetermined location with dependable electricity.

Never operate a gas-powered generator, barbecue, or fuel-burning appliance inside a home, garage, or other enclosed area because of the risk of carbon monoxide poisoning.

Families can also contact their electricity provider to ask whether it maintains a registry or notification process for customers who rely on life-sustaining equipment. Registration does not guarantee uninterrupted power or priority restoration, so an independent backup plan is still essential.

4. Keep an Adequate Supply of Medications

Running out of medication can become dangerous quickly, particularly when a child takes anticonvulsants, respiratory medications, cardiac medications, insulin, steroids, or other time-sensitive treatments.

Where permitted by the pharmacy and prescribing team, keep enough medication available to manage an interruption in normal services.

The emergency medication plan should include:

• An updated medication list

• Copies of current prescriptions

• The prescribing provider's information

• Pharmacy contact information

• Instructions for rescue medications

• Required syringes, adapters, or administration supplies

• A refill tracking system

• Instructions for medications requiring refrigeration

• A method for recording when emergency doses are given

SickKids advises caregivers to track medication refills so that essential medications do not run out and to follow the required storage instructions for each medication.

Do not transfer medications into unlabelled containers. Keep them in their pharmacy-labelled packaging whenever possible.

Ask a pharmacist what to do if a refrigerated medication becomes warm, freezes, is exposed to excessive heat, or cannot be kept within its required temperature range.

5. Prepare Backup Feeding and Hydration Supplies

Children who rely on enteral feeding may require a more detailed emergency nutrition plan.

Keep a supply of:

• Prescribed formula

• Safe water

• Feeding bags and tubing

• Extension sets

• Syringes

• Venting supplies

• Tube replacement supplies, where prescribed

• Oral rehydration products, if recommended

• Written feeding instructions

• A manual feeding plan

If the child normally uses a feeding pump, ask the clinical team whether feeds can safely be given by gravity or syringe if the pump cannot be used.

Do not assume the standard feeding schedule can simply be changed during an emergency. Some children may be at risk of aspiration, low blood sugar, dehydration, electrolyte imbalance, or feeding intolerance.

Any backup feeding method should be reviewed and approved by the child's healthcare team before it is needed.

6. Know the Manual Alternatives

Technology supports many aspects of complex paediatric care, but equipment can fail.

Caregivers should know which interventions can be completed manually and should be trained before an emergency occurs.

Depending on the child's needs, this may include:

• Manual ventilation using a resuscitation bag

• Manual suction

• Gravity or syringe feeding

• Manual transfers

• Administering medications without a pump

• Checking symptoms when electronic monitoring is unavailable

• Using backup oxygen cylinders

• Replacing a tracheostomy or feeding tube, if included in the child's plan

Written instructions should be stored with the corresponding equipment.

All regular caregivers, including family members, home care nurses, respite workers, and school staff, should understand their responsibilities and remain current in any required training.

7. Build a Reliable Support Network

In an emergency, one caregiver may not be able to manage everything alone.

Identify at least two or three people who understand the child's needs and could assist with:

• Providing care

• Transporting the child

• Collecting medications or supplies

• Caring for siblings

• Bringing equipment to the hospital

• Communicating with healthcare providers

• Supporting an evacuation

• Taking over if the primary caregiver becomes unavailable

Government of Canada emergency guidance recommends developing a personal support network and ensuring that trusted people understand the individual's emergency needs.

Provide alternate caregivers with the emergency plan and make sure they know where supplies, medication, and equipment are stored.

For children requiring highly skilled care, families should also discuss contingency coverage with their nursing provider. The plan should identify whom to contact if a scheduled caregiver cannot attend and what the family should do when immediate replacement coverage is unavailable.

8. Plan Where You Would Go

Not every emergency requires evacuation, but families should know where they could go if the home becomes unsafe.

Potential locations may include:

• A family member's accessible home

• A hotel with dependable electricity

• A hospital

• A designated community location

• An emergency shelter able to accommodate medical equipment

• Another prearranged location with backup power

Before relying on a location, consider:

• Accessibility

• Electricity and charging capacity

• Space for medical equipment

• Refrigerator access

• Proximity to a hospital

• Transportation options

• Infection risks

• Whether home care staff can attend

• Whether oxygen and other supplies are permitted

• Whether the child can be safely transferred and positioned

Standard emergency shelters may not be equipped to provide nursing care or operate specialized medical devices. Contact your municipality in advance to learn how residents with complex medical or accessibility needs are supported during evacuations.

9. Prepare for Emergency Transportation

Consider how the child and all essential equipment would be transported if the family had to leave quickly.

The plan should address:

• An accessible vehicle

• Car seats or specialized restraint systems

• Wheelchair transportation

• Portable oxygen

• Equipment that must remain running during travel

• Where batteries and chargers will be placed

• How the child will be transferred

• Who will accompany the child

• Who will bring the remaining supplies

• Which hospital the family would usually attend

Keep the vehicle's fuel level from becoming too low, particularly during severe weather alerts or other periods of increased risk.

When calling emergency services, tell the dispatcher that the child has complex medical needs and identify any ventilator, tracheostomy, oxygen, mobility, or communication requirements.

10. Include the School and Community Care Team

Emergency planning should extend beyond the family home.

The child's school, childcare provider, respite program, transportation provider, and home care agency should have current information about:

• Medications and rescue medications

• Emergency contacts

• Equipment

• Evacuation needs

• Communication needs

• Mobility and transfer requirements

• Feeding support

• Respiratory interventions

• Signs of deterioration

• When to call emergency services

Ask how the organization manages power failures, severe weather, lockdowns, evacuations, and delayed transportation.

Families should also confirm who is responsible for bringing the child's emergency supplies when travelling between home, school, appointments, and respite care.

11. Practice the Plan

An emergency plan is most useful when everyone has practised it.

Run through realistic scenarios, such as:

• The power goes out overnight.

• The suction machine stops working.

• A feeding pump fails.

• The family must leave the house within 15 minutes.

• The primary caregiver becomes ill.

• The child's oxygen needs increase.

• A home care nurse cannot attend.

• The child needs emergency transport during severe weather.

During the practice, note what is difficult, missing, expired, inaccessible, or unclear.

Review emergency plans and supplies at least twice a year. It can be helpful to schedule reviews around daylight saving time changes, the start of the school year, or another date the family will remember.

12. Know When to Call for Emergency Help

Families know their children best, but they should not hesitate to call 911 when a child is experiencing a life-threatening emergency or cannot be safely supported using the established home plan.

Call for emergency assistance for concerns such as:

• Severe difficulty breathing

• Blue or grey colouring

• Loss of consciousness

• A prolonged seizure or seizure emergency

• Failure of essential life-sustaining equipment without a safe backup

• Inability to ventilate or clear the airway

• Severe allergic reaction

• Uncontrolled bleeding

• A sudden major change from the child's normal baseline

Follow the child's individualized emergency plan and the instructions provided by their healthcare team.

Preparedness Creates Confidence

Families of medically complex children already manage an extraordinary amount of information, equipment, and responsibility.

Emergency preparedness does not eliminate every risk. It creates a structure for responding when circumstances change quickly.

A written emergency plan, portable medical bag, backup power strategy, adequate medications and supplies, trained support network, and practised evacuation plan can help families protect the routines and interventions their child depends on.

Most importantly, the plan should be individualized. Families should develop it with their child's healthcare providers, equipment companies, pharmacy, home care team, school, and emergency support network.

How The Care Company Can Help

At The Care Company, we understand that caring for a medically complex child requires more than completing a list of clinical tasks.

Our paediatric nurses support children who may require tracheostomy and ventilator care, enteral feeding, oxygen, suctioning, medication administration, seizure monitoring, airway clearance, mobility assistance, and other complex interventions at home.

We work with families and healthcare partners to understand each child's care plan, baseline, equipment, routines, and emergency protocols. Our goal is to help families maintain safe, consistent care while allowing children to remain connected to home, school, and family life.

Contact The Care Company to learn more about our complex paediatric nursing and home care services.