Dialysis community learns from past disasters

This month marks the 10^th anniversary of Hurricane Katrina. It was one of the deadliest hurricanes in U.S. history, and the costliest. Officials have confirmed 1,833 deaths related to the storm activity, and close to $108 billion in damages.

For the dialysis community, the hurricane was transformative. It helped led to the creation of the Kidney Community Emergency Response coalition, and disaster response teams within dialysis organizations.

"At the time we had limited resources to support our efforts in terms of mobile generators, water tankers, gasoline, diesel, mobile homes and personnel generators," Bob Loeper, vice president of Fresenius Medical Services’ Strategic Project Management told NN&I. "Today we are much better equipped to handle such a disaster."

In NN&I's August issue, we talked to two members of the Fresenius Medical Care Disaster Team that responded to Hurricane Katrina 10 years ago: Bill Numbers, senior vice president of Operations Shared Services, and Bob Loeper. We also interviewed Numbers in the weeks following Hurricane Katrina, and he kept us updated on the status of dialysis clinics in the region.

“Three things are at the top of our list: generators, water, and fuel," Numbers told us in 2005. (Read NN&I's 2005 coverage of the hurricane and the dialysis community's response.)

Debbie Wolfe RN, BS, Divisional Vice President for DaVita Kidney Care wrote in NN&I's August issue that DaVita has also improved its emergency response capabilities. "We have developed better disaster response coordination," said Wolfe, who lives outside New Orleans in Belle Chasse, La., and knows first hand the devastation caused by Hurricane Katrina. "As a result of Katrina, we realized that we needed a true disaster preparation and response team and so we created the DaVita Village Emergency Response Team (DaVERT), a multi-disciplinary group dedicated to provide a wide range of support during natural disasters and other emergencies, natural and manmade."

Dialysis providers do seem to be better prepared for the aftermath of a large storm. These new response teams provide a valuable resource, not just to help prepare for disasters, but to help learn from them as well. KCER helped coordinate efforts between dialysis providers and ESRD Networks during Hurricane Sandy in Oct. 2012.

KCER recently updated its Save a Life brochure, which has now been named "Kidney Care in Emergencies: Community Considerations." The Save A Life Brochure was originally created by KCER and one of its Committees in 2010. In late 2014 through 2015, the KCER Communications Committee decided to revise and update the brochure. The purpose of the brochure is to educate a variety of stakeholders outside of the ESRD community about dialysis and the need for utilities and resources, especially during disasters. The brochure has been received positively since 2010 and the intended audience of the material includes any external stakeholders that may assist the dialysis community in a disaster.

Learning from Hurricane Sandy

Sandy was the second costliest Atlantic hurricane, behind only Katrina. During Sandy, dialysis patients and staff experienced power outages and homes that were severely damaged or lost due to flooding and wind.

The dialysis community is still learning from Sandy. A study published in July in the American Journal of Kidney Diseases found that New York and New Jersey patients who received early dialysis prior to Hurricane Sandy had 20% lower odds of visiting the emergency department, 21% lower odds of a hospitalization in the week of the storm, and 28% lower odds of death 30 days after the storm. And a recent study in the Clinical Journal of the American Society of Nephrology found that patients whose dialysis centers distributed a dialysis emergency packet were more likely to later have copies of their medical records stored at home.

Areas for improvement

The CJASN study showed that many dialysis patients are still unprepared for disaster, and highlighted factors important for avoiding missed dialysis treatments, such as having access to alternate dialysis in an integrated system, getting access to transportation, and having a stable social situation.

Transportation was a major issue during Sandy, and Numbers and Loeper highlighted it as an area in need of improvement.

"We need to have transportation companies improve their disaster plans. Many times our clinics are open but the transportation companies do not have a plan to pick up patients in bad weather," Numbers said. "Also, not all states allow nurses from other states to treat patients. About half of the states do allow this and we are currently supporting nurse compact legislation that allows a licensed nurse to work in any state that joins the compact."

Loeper said it is crucial that dialysis staff evacuate an area if it is ordered. If staff stays behind to run the clinics, then it sends a message to patients that evacuation may not be necessary. Many have learned from experience to heed the warnings. "As a direct result of Katrina, residents of New Orleans are more likely to evacuate the city if the government advises them to do so," Wolfe wrote. -by Rebecca Zumoff