BRIEF COMMENT

Emergency Preparedness for Dialysis Facilities

Ajay K. Singh MBBS, FRCP

Brigham and Women’s Hospital

Harvard Medical School

Two weeks ago Sunday, we were bracing ourselves for Hurricane Irene as it was hurtling up the east coast. As it turned out, the hurricane lost some of its severity after making land-fall in North Carolina, and by the time Irene reached us here in Boston, it was a tropical storm. Elsewhere in towns and cities across the east coast, especially in New Jersey and in the New England State of Vermont, there was some loss of life and quite extensive damage to property mostly from the effects of flooding and power failures. However, most everyone was relieved because the effects of Irene could have been much worse. There wasn't the impact on dialysis facilities that occurred after Katrina.  The overarching verdict on the response of public officials and first responders was that they did a great job. The verdict on how dialysis providers responded was also positive. For the first time, perhaps, the preparation involved notices via the social media.

But what if there is a big natural disaster, or even a catastrophic man-made disaster (today is the 10th anniversary of 9/11)? Has the dialysis community learned lessons from previous disasters? Kenney's article received a lot of attention when it was published a few years ago CJASN, but it is just as relevant today as it was back then, because in the event of a natural disaster, how our patients and we respond could save lives. Others have also discussed disaster preparedness -- the article from Jeff Kopp and colleagues from 2005 is also worth reading. CMS has published a booklet on emergency preparedness (see link)

Since Kenney’s article is available in CJASN with open access, I won’t spend too much time reviewing it, other than highlighting a few important points that he makes:

1. Informational resources for dialysis disaster planning are available and relatively easy to find, thanks to the Internet. CMS has published Emergency Preparedness for Dialysis Facilities (8). The NKF has also produced a document entitled "Planning for Natural Disasters and Other Types of Emergencies (Facilities)" 
2. There is organizational infrastructure already in place. For example, the International Society of Nephrology created the Renal Disaster Relief Task Force in 1989, with branches serving three large areas: The Americas; Southeast Asia; and Europe, Asia Minor, the Middle East, and Africa. In the United States, there is a group known as the Kidney Community Emergency Response Coalition (KCERC).
3. Most disaster planning and preparations should be accomplished well before a crisis may occur. Kenney makes the point -- particularly germane for hurricanes because there is some advanced notice -- that proper planning and subsequent patient and staff education may allow dialysis facilities to continue to care safely and effectively for ESRD patients. Kenney discusses the importance of hazard mitigation. He defines hazard mitigation as the process of minimizing losses by reducing risks in advance of a crisis. He emphasizes the importance of developing a communication plan. As well, understanding the infrastructure of the dialysis unit – making contingency plans for water (e.g., confirming contracts for backup water), electricity (e.g., back-up generator).
4. Re-opening the dialysis facility after a disaster. Deciding whether the unit is structurally safe, whether the water can be used, and managing resources (e.g., staff).
5. Addressing the needs of special populations: for example children and patient’s on peritoneal dialysis.
   
   
   References
   1. Kenney RJ. Emergency preparedness concepts for dialysis facilities: reawakened after Hurricane Katrina. Clin J Am Soc Nephrol. 2007 Jul;2(4):809-13. Epub 2007 Jun 20. 
   
   
   2. Kopp JB, Ball LK, Cohen A, Kenney RJ, Lempert KD, Miller PE, Muntner P, Qureshi N, Yelton SA. Kidney patient care in disasters: emergency planning for patients and dialysis facilities.Clin J Am Soc Nephrol. 2007 Jul;2(4):825-38. Epub 2007 Jun 20. PubMed PMID: 17699500.
   
   
   3. Kopp JB, Ball LK, Cohen A, Kenney RJ, Lempert KD, Miller PE, Muntner P, Qureshi N, Yelton SA. Kidney patient care in disasters: lessons from the hurricanes and earthquake of 2005. Clin J Am Soc Nephrol. 2007 Jul;2(4):814-24. Epub 2007 Jun 20. PubMed PMID: 17699499.