How a Dialysis Center Prepares for a Natural Disaster

On Oct. 10, 2018 at 1:00 p.m., Hurricane Michael came ashore east of Panama City, Florida. With winds of 155 mph, this date and time in history will be remembered by locals for a long time. Hurricane season begins June 1 and lasts through November 30. Long before the season begins, preparations on how to educate our dialysis patients are already underway. Keeping patient safety in mind, each center prepares for a natural disaster in different ways and as appropriate for each modality. Patients are taught to pay attention to the different signs posted in the center that let them know of inclement weather as it approaches. Emergency packets are made for each patient in the facility and given to them during the last week of May. The following items are included inside each packet:

• Patient demographics
• Dialysis orders (Kardex)
• Medication list
• Copy of insurance cards
• Curfew letter from the facility
• Letter for the ESRD network (Example: Florida Network 7)
• Emergency phone numbers
• List of shelters
• List of emergency supplies to be kept in your emergency kit, along with instructions on how to disinfect water (to follow should a boil requirement goes into effect)
• Current laboratory results
• Medical history and physical exam results
• Emergency diet plan

All patients, whether on hemodialysis (HD), peritoneal dialysis (PD) or home hemodialysis (HHD), need to revert back to the three-day emergency diet (presented here) during these type of events. Patients must keep their own modality in mind when making preparations for the upcoming inclement weather. For example, PD patients must keep bottled water on hand, not only for drinking, but for washing their hands and cleaning around their exit site. The care team can help patients determine what additional items may be needed based on their modality.

Natural disasters often occur without warning and it is important to be prepared at all times. Thus, the dialysis center’s emergency procedure is reviewed quarterly and the disaster/emergency plan is reviewed annually, as well. Ongoing communication prior to, during and immediately after an event among teammates, patients and medical directors is the most important part of a successful plan.

As a reminder, here are a few important instructions to give your patients when educating them—before a storm hits or a disaster strikes:

1. Stay home, call your center—if you have phone service—to find out if it is open.
2. Call family members and let them know that you are alive and how you are doing.
3. Listen to public announcements with a battery operated radio. It is recommended you pack one in your emergency kit.
4. Have your area or city emergency management phone number and web address readily available.
5. Have the medical emergency shelter phone number accessible or programmed in your phone.

Most importantly, instruct patients to follow evacuation advisories and that if they plan on evacuating, to do so early on before the weather gets bad; also they should let someone know where they are at all times. Remind patients that if they evacuate to the emergency medical shelter, they need to let staff know that they are a dialysis patient and where they dialyze. Have the administrative assistant or social worker update any changes to patients’ demographics at least quarterly and annually in the system.

Tell patients that if they get out in flood waters, the water could be contaminated with sewage. If avoiding the flood waters is not possible, they should take precautions and wear knee high boots, a long-sleeve shirt, long pants, rubber gloves and goggles for protection. Water needs to be boiled for at least 1 minute before using it to brush teeth. Well water needs to be tested for coliform bacteria as soon as possible; not to be used until it has been disinfected with chlorine and it is safe for consumption. Home patients on PD should cover their exit site with an occlusive dressing when wading in flood waters. Also, they cannot use any of their home supplies if they have gotten wet; the same goes for HHD patients. Just prior to performing their treatment, PD patients must wash their hands with antibacterial soap and bottled water or use hand sanitizer when clean tap water is not available.

During an event, the center’s staff should respond by:

• Determining facility status
• Approving emergency orders
• Monitoring water quality for dialysis

During recovery (post-event), the center’s staff needs to provide a timeline to resume normal treatment, review damage assessment and provide operational clearance.

In summary, it is of upmost importance for patients to have an emergency plan at home and communicate this to the dialysis staff in order to help the center care for their needs in a more efficient manner in the event of an emergency. It is of vital importance for patients to keep the center’s staff aware of any changes in their living arrangements, phone numbers, address, etc. The center also needs to have updated contact information for teammates, as well. Everyone needs to be prepared and have a plan before disaster strikes.

Plan for the worst, hope for best and be prepared!