Dialysis during a disaster: A first-person account

Lessons learned from Hurricane Katrina

Editor's note: On August 29, 2005, the residents of New Orleans experienced Mother Nature at her worst. Katrina unleashed its fury on the town and surrounding parishes. The category 5 hurricane, the fifth of that season, leveled homes, flooded streets and highways, and sent residents fleeing for their lives. Officials confirmed 1,833 deaths related to the storm activity, and close to $108 billion in damages, making it the costliest natural disaster, as well as one of the five deadliest hurricanes in the history of the United States. Amazingly, water reached 6–12 miles inland from the coastal beaches.

In the midst of all the chaos were individuals who needed life-dependent dialysis treatments. How did they fare during this disaster, and what did dialysis providers learn from the experience? We present here recollections from those who were on the front lines a decade ago and treated patients in the Louisiana area who were impacted by Hurricane Katrina, along with information on resources for the renal community to prepare for disasters in the future.

Everyone knows about the devastation caused by Hurricane Katrina. They saw the news footage of water pouring over the levees, people standing on the roofs of their houses, and swarms of local residents seeking refuge at the Superdome.

But being from New Orleans and having experienced Katrina first hand, I can tell you that everyone’s experience is unique. For me, the event revolved around two key considerations: Making sure my family was safe and doing what I could to help the highly vulnerable community of dialysis patients who typically require thrice-weekly treatments to stay alive. What people may not remember—but we in South Louisiana will never forget—is that Hurricane Katrina was initially projected to hit land farther east, leaving South Louisiana protected.

Read more from this series: Lessons the dialysis community learned from Hurricane Katrina

However, as with every hurricane, the New Orleans area (much like the rest of the Gulf Coast) started preparation work the entire week prior to the event in case it happened to strike the area. Even though we thought it was going to hit the Florida panhandle, we prepared our dialysis patients by making sure they had their hurricane packets ready.

At the start of every hurricane season, in anticipation of a potential event, we create a hurricane packet for all of our patients. The hurricane packet contains all treatment orders, the care plan, flow sheets, lab work that needs to be done and a patient’s diet info. These packets are created so that if a patient needs to evacuate an area, they have a mini medical record that will allow another center to be comfortable treating them.

We also educate the patients on protocols they should follow to help keep them safe. Part of that discussion is educating them about a “disaster diet” that restricts potassium and fluid, allowing them to go longer between treatments if necessary. We also ask them, ‘What’s your evacuation plan?’

The problem was that many New Orleanians either didn’t believe the storm would be so strong or they outright refused to leave. Many were heard to utter things like, “I’m not going anywhere. I endured Hurricane Betsy in the ‘60s and I can handle this.” Sadly, these same people are the ones who we saw on the news on the roofs of their houses.

When the storm path continued toward New Orleans, we contacted as many patients as we could to get them treated early. Late on the night of Aug. 27, the National Weather Service predicted that a Category 5 hurricane would strike New Orleans. Initially we were most worried about wind damage, as previous storms had destroyed roofs. So we prepped facilities by doing what we could to safeguard equipment in the dialysis centers – wrapping dialysis machines and computers in plastic, for example. By Sunday morning (Aug. 28), we realized we had done all we could and waited for the storm to strike.

Evacuation begins

I live in Belle Chasse, southeast of downtown New Orleans. When the weather service predicted that we would be hit hard, we were evacuated all the way to Monroe, La., in the northern part of the state. When Katrina hit, the winds were so strong that many people in Monroe lost power. And Monroe is nearly 300 miles from New Orleans.

The storm hit Monday morning (Aug. 29) and we started heading back from Monroe on Tuesday morning. We stopped for lunch in Baton Rouge and it was on a TV at the restaurant that I saw that the levees had been breached. This was the start of a failure of the levees that flooded 80% of New Orleans and all of neighboring St. Bernard Parish. Since getting into or anywhere near the city was impossible, I ended up staying at a coworker’s house.

Communication lines cut

While chaotic at every level, the biggest problem for the area was that all communication failed in the aftermath of Katrina. The local police could not talk to each other, or the state police, or the firefighters or the federal authorities. For days, no one could coordinate anything. This obviously hampered our efforts as well. Starting Tuesday (Aug. 30), we were on 5-6 conference calls a day. But even that was a challenge because there were very few cell towers and most of the landlines were down. Thankfully, I could connect via a landline, but I could only connect via an 800 number. All local numbers were inaccessible so I couldn’t call anyone locally and no one could call me. Once we gathered on calls, the primary goal was to track down patients and teammates. Next was to see about getting facilities up and running.

In anticipation of the storm, we had prepositioned portable generators in Pensacola, Florida, which was the closest location we could store them without fear of them being damaged by the storm. But there were other concerns: reports of mass hysteria in the aftermath of the storm. The safety of our teammates was at risk and we heard reports that trucks were being hijacked for gas.

It took until Saturday (Sept. 3) before we got our first center back up and running and that center was on the north side of Lake Ponchartrain, where the damage was due to wind and not water. That facility, in the town of Bogalusa, right on the Mississippi border, had power but no water. So the facility administrator worked with the local fire department to connect a fire truck to the facility’s water treatment system. Once the center was up and running we started treating patients around the clock. We treated any and all patients who came in and needed treatments.

Our hands were tied in terms of reaching patients in the areas hardest hit by the storm. There was a prohibition against entering the New Orleans city limits, so we couldn’t even assess the damage done to our centers and what it would take to get them back up and running. And there were parts of the city we still couldn’t access a week after the storm hit. But we did what we could to help. We brought three motorhomes to the area to provide displaced teammates with a place to live. As our facilities came back online, we brought teammates back to work, even if there were no patients to treat.

Summary

While this, hopefully, was a once-in- a-lifetime catastrophe, there were two takeaways for local caregivers and the company as a whole. - Patient education remains critical. We will continue to prepare for hurricane season, but 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.

We have developed better disaster response coordination. 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. -by Debbie Wolfe, RN, BS

Resources

KCER (Kidney Community Emergency Response) The KCER Coalition provides technical assistance to End Stage Renal Disease Networks, kidney organizations, and other groups to ensure timely and efficient disaster preparedness, response, and recovery for the kidney community.

English: http://kcercoalition.com/

Español: http://kcercoalition.com/resources/en-espanol/

Preparing for emergencies: A guide for people on dialysis http://kcercoalition.com/wp-content/uploads/2013/01/101501.pdf

How to make an emergency plan www.ready.gov

Have an emergency plan in place before a disaster happens. This website is a good resource to help make your plan for your household members and your pets.

For other languages: www.ready.gov/languages

Build A Go Kit www.Ready.gov

English: www.ready.gov/build-a-kit

Español: www.ready.gov/es/como-preparar-un-kit

Emergency Resources / Connect with Household Members: American Red Cross

Once your plan is made, here are useful emergency tips. This website can help you connect with family and household members in an emergency.

English: www.redcross.org

Español: www.redcross.org/cruz-roja