Disaster Preparedness for Dialysis Facilities
Sandra Copeland
Q:
With all of the disasters such as hurricanes, floods, and tornadoes
that have occurred recently and the continued threat of terrorism, what
steps can be taken to meet these challenges and provide a safe
environment for patients on dialysis?
A: In today’s environment of almost constant threats of extreme weather
and terrorism, it is essential that dialysis facilities are prepared to
function despite the challenges presented in the crisis. Disasters can
be defined as “natural” and “man-made” but may carry many of the same
consequences and issues to deal with.
Natural Disasters
Natural
disasters may include such events as hurricanes, tornadoes, floods,
earthquakes, fires, blizzards, and others specific to topography
(tsunamis, monsoons, volcanic eruption).
Man-Made Disasters
Terrorist
activities such as bombs and chemical and biological weapons are
considered man-made disasters. Fires, airplane crashes, failed
equipment in water treatment facilities, and building collapse are some
examples of man-made disasters that are not terroristic in nature.
Regardless of the type of disaster, the needs for power, water,
communication, and transportation are the same for all of them. While
some disasters like hurricanes allow more advanced notification, the
need for preparation and action remains an important consideration. Planning and Coordinating
When
developing a comprehensive plan, the first crucial step is to form a
multidisciplinary group to include community utility representatives,
American Red Cross Workers, and the state Emergency Management Agency.
These members will meet with your facility groups including clinical
(patient care), plant operations, security, dietary, medical records,
administration, and any others deemed appropriate (Counts, 2001). The
community representatives need to be familiar with the facility plan so
that when a disaster occurs, the flow of services can be determined.
The same is true for the facility; the facility needs to know what
community assistance will be available before a disaster occurs.
Regular periodic meetings should continue even after the plan is in
place to determine what changes need to be made, especially as
community resources continue to be scaled back by budget cuts.
There is some basic information that the dialysis facility needs to
have and this should be communicated to the local utilities and EMA.
For example, the facility should know about how many patients they
could potentially dialyze in a day, about how many gallons of water
would be needed to accommodate that number (including any used for
disinfection), and what supplies might be needed for each type of
disaster that are unique to ESRD patients. Local radio and television
stations should announce that all patients requiring dialysis should
evacuate to a “skilled” emergency shelter if evacuation is necessary.
The American Red Cross can then communicate the need for dialysis and
facilities can be prepared.
The dialysis facility also needs to have telephone numbers available
for equipment suppliers who may be able to ship emergency supplies
until normal routines are re-established, employment agencies who could
supply temporary emergency staff, vendors who could supply food-grade
tankers to replenish water supplies, telephone numbers and contact
people for all local outpatient and inpatient centers in case back-up
is needed, and emergency contact numbers for nephrologists and staff
members.
In addition, the dialysis facility should be well versed in tips for
water conservation, emergency disconnects, the processes of patient
identification and evacuation, what to do in a boil water advisory,
emergency supply kits and supplies, and power failure procedures.
Vendors and consultants can provide tips for their respective equipment.
Publications Available
The National Kidney Foundation booklet “Planning for Natural
Disasters and Other Types of Emergencies: A Guide for Renal Facilities”
is free from their website and contains sample forms and supply lists
for patients, including a three day meal plan for emergencies (NKF,
1999). It would be valuable to have packets of these plans and
resources already made to give to patients or to give them to patients
before disasters occur. The Centers for Medicare and Medicaid Services
(2002) also offers for free on their website “Preparing for
Emergencies: A Guide for People on Dialysis.” The Centers for Disease
Control also offer guidance for dialyzing patients during a “boil
water” advisory (CDC, 2004).
Issues To Be Considered
Peripheral collateral impact is a concept that is often encountered
in disasters. This occurs when a disaster occurs in one location or
region but needs are affected in regions peripheral to the disaster.
For example, if a hurricane is predicted to make landfall in Savannah,
Georgia and that area is ordered to evacuate, then areas in middle
Georgia are forced to assume the added volume of patients requiring
dialysis who have evacuated and are staying in hotels or shelters. On a
somewhat smaller scale, if an entire community is flooded and water is
unavailable, the hospitals are more likely to assume larger burdens of
accommodating patients because outpatient centers do not have the same
priority in the EMA framework as acute care facilities and will not
have the resources available to get back on line as soon as hospitals.
References
Centers
for Disease Control Division of Healthcare Quality Promotion (2004).
Notice: Guidance for healthcare providers, what to do when your
municipal water supplier issues a “boil water” advisory. Retrieved on
October 22, 2004 from
www.cdc.gov/ncidod/hip/dialysis/boilwater_advisory.htm
Centers for Medicare and Medicaid Services. (2002). Preparing for
emergencies: A guide for people on dialysis. Retrieved October 30, 2005
from http://www.healthyarkansas.com/hurricane/pdfs-hurricane/10150.pdf
Counts, C. (2001). Disaster preparedness: Is your unit ready? Nephrology Nursing Journal, 28(5) 491-499.
National Kidney Foundation (1999). Planning for natural disasters and
other types of emergencies: A guide for renal facilities. Retrieved
October 30, 2005 from
http://www.kidney.org/atoz/pdf/disaster_prepardness.pdf
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