Dialysis providers dig out from Hercules, Ion

Winter storms pounded nearly two dozen states in the Midwest and the Northeast this past weekend, creating frigid weather for NFL playoff games and placing the term “polar vortex” into the weather forecast vernacular.

And, while climates are expected to return to their seasonal norms––cities like Minneapolis and Chicago will move up from below-zero temperatures to the upper 30s by this weekend––the bitter cold set emergency teams in motion in most kidney communities east of the Mississippi.

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“We had a handful of facilities that did close,” during winter storm Hercules, said Tom Bradsell, who heads Davita’s Village Emergency Response Team. “There was a lot of ice predicted with the rain and snow. ”

Hercules set the table for an icy cold experience last weekend; winter storm Ion followed up with more damage, bringing in frigid temperatures and more snow. Meteorologists blamed the polar vortex for losing control in the Arctic regions of the Northern Hemisphere, where it typically keeps strong, upper-level winds going in a counterclockwise direction and keeping the bitter cold air locked up. Somehow the vortex became distorted and traveled farther south than normal, sending cold air downward. The cold weather was felt as far south as Alabama.

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The Kidney Community Emergency Response Coalition met with Centers for Medicare & Medicaid Services officials during winter storm Hercules to assess the impact. KCER sent out an extreme cold weather guide to the ESRD Networks, CMS, and to large dialysis organizations over the weekend.

Preparing for the chill
With a warning of the cold temperatures ahead, dialysis providers scheduled patients in early for treatment before roads iced up and closed. Bradsell said that was Davita’s approach to the emergency; once patients were dialyzed and sent home, clinics in areas where travel was restricted closed their doors. Ultimately, Davita closed 25 facilities after the cumulative effects from winter storm Ion, including in states like Illinois, Indiana (governors in both states declared a state of emergency and restricted travel), Kentucky, Tennessee, and Ohio. Only a few communities reported power outages, Bradsell said.

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In New York, the IPRO ESRD Network reported on their website Jan. 3 that a number of facilities were closed in the Bronx, as well as in Garden City, Huntington, Lynbrook, Port Washington, Medford, and Astoria due to the storm, but a follow-up report Jan. 7 indicated the facilities had resumed operations. The Renal Network Inc., representing Midwestern states such as Indiana, Ohio, and Illinois, reported that 355 of 400 dialysis facilities believed to be in the path of the storms had remained opened. Twenty-five were closed; seven were unreachable and presumed closed, and 13 were running alternate or shortened schedules during the height of the storm, the network reported.

American Renal Associates, which operates more than 120 clinics in the United States, reported facilities in the storm’s path opened later in the day but experienced no problems with patients or staff arriving for treatments.

At Fresenius Medical Care North America, a handful of clinics were closed in New Jersey, said Babajide Salako, Director of Operations Support and Global Disaster Response, and some clinics in New York and in the New England region opened later in the day. The dialysis provider has developed a plan to customize its disaster preparedness plans by region; each region has about 50 clinics, Salako said, and the plans are developed around the unique climate of that region. “If you have a clinic that is 10 miles from the bay, you need to have sandbags available,” Salako said. “If you are in a cold weather area, you want to make sure you have more cranking power on your generators.”

But Salako said the biggest problem in winter storms is reliable transportation for patients. Many transportation companies don’t have their own disaster plans – and are not required to have one. “That is the biggest Achilles heel for us. They need to have a plan” when their vehicles can’t get through the snow and ice, Salako said. -by Mark Neumann