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Lessons the dialysis community learned from Hurricane Katrina
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Editor's note: We posed a series of questions 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, vice president of Fresenius Medical Services’ Strategic Project Management.
NN&I: How would you rank Katrina in terms of severity, based on the number of disasters that your group has faced?
Bill Numbers: It was the worst, considering the resources available at the time. Approximately 100 facilities and 7,000 patients were impacted by the storm; although some of our facilities only had to change patient schedules, many others were damaged or completely destroyed.
Bob Loeper: 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. Today we are much better equipped to handle such a disaster.
Read more from this series: Dialysis during a Hurricane Katrina: A first-person account
NN&I: Did the location (Louisiana) make responding to this storm more difficult?
Numbers: So many patients and staff had to evacuate, some traveled as far away as Cape Cod. Actually the location of the storm was a help. We had so many clinics in the area it made it possible to handle all of our Fresenius Medical Care patients and we performed more than 1,000 treatments for patients who were not originally with Fresenius.
Loeper: We also arranged to have approximately 20 mobile homes driven in from all corners of the U.S. by fellow regional vice presidents who equipped these with food, clothing, and medical supplies. We picked up Fresenius Medical Care staff along the way that wanted to help out.
NN&I: Do you think the state emergency system and federal support was adequate?
Numbers: We received a lot of support from the Federal Emergency Management Agency, paying for housing and reimbursing us for living expenses for our employees who had to stay and treat the patients. We had every day communication with FEMA and that was a big help. Also, CMS jumped right in and held daily conference calls assisting us to coordinate with the State Emergency Operations Centers. At the time, the local Emergency Operation Centers (EOCs) did not know much about dialysis facilities and did not plan to assist us. Now, every EOC near a dialysis clinic is aware of their location.
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.
NN&I: What was the key to getting your clinics up and running ASAP?
Numbers: We had very good relationships with construction companies because we were building, relocating, or expanding more than 100 clinics a year. All of the construction companies and developers were extremely supportive and made our dialysis clinics an immediate priority. We already had national contracts for diesel fuel for our backup generators and we also knew where to get water because of previous situations when city water shut down for treatment plant problems or well problems.
We were able to use our experience from around the country to focus on our needs in the New Orleans area. We also had 200 employees who immediately volunteered to come and assist. There were more than 100 nurses in the group. People from Spectra Labs brought their transportation vehicles and picked up people at the airport and cleaned our clinics. Our dialysis supply transportation group, True Blue Logistics, brought us dialysis supplies, paper goods, food, ice and anything else we needed.
Loeper: We also provided temporary housing and gasoline for our local staff so they could come to work. If we didn’t take care of our staff, we wouldn’t have been able to take care of our patients. This was the mantra we learned from Katrina.
NN&I: Can we make improvements on how we prepare patients for disasters?
Numbers: 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. 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: If an evacuation is ordered, then everyone really must evacuate. If we stay behind and try to staff our operations, then patients may not evacuate, which is placing everyone at risk.
We have learned how to configure storage and water treatment systems so that minor flooding will not cause a problem.
NN&I: What were the lessons learned from Katrina about handling disasters?
Numbers: At the time of Katrina, our Incident Command Center handled coordination of all of the company’s emergency preparedness and disaster response resources. Now, each of our Regional Vice Presidents are the Incident Commander for their Region of about 50 clinics. Also, we stay more connected to CMS through KCER, the Kidney Community Emergency Response Coalition. One major improvement has been the amount of resources we now have available. We have more than 1,000 personal home generators for our staff so their families can be safe when our employees go to work. Additionally, our patient emergency call capabilities are much better, utilizing hundreds of staff who talk to patients, doctors and hospitals every day, They are perfectly positioned to help a patient find an open clinic immediately.
Loeper: Since Katrina we developed and annually update a Regional Disaster Preparedness Manual that provides templates and a checklist for each region to be prepared for disasters. We believe that local resources are key. We cannot have our regions dependent on corporate resources, which are now available to assist, advise and coordinate. The regions have to be the first responders with their local resources and contacts. This is the key to our success today,
NN&I: Any changes to how FMC facilities are equipped or built today (architecture, design, materials, etc.) that reflect lessons from Katrina?
Numbers: We have learned how to configure storage and water treatment systems so that minor flooding will not cause a problem. Major flooding is still a problem. In states where ice storms and power outages happen, we have generators in all facilities and other mobile generators on standby.
Loeper: Many locations and new facilities have changed design standards to either install generators or the Automatic Transfer Switch (ATS), which allows a mobile generator to connect to a facility. We also install external water connections to allow water tankers a direct feed to our water system.
Staying open: The fury of Katrina on dialysis operations
Number of patients in the storm’s path: approximately 5,000 patients
Number of clinics providing care affected by the storm: 94
Louisiana: 55
Mississippi: 30
Alabama: 9
Closures: More than two-thirds of the 55 Louisiana clinics were reported to have closed for greater than or equal to 10 days after the storm. Among the 40 Louisiana clinics located in the New Orleans metropolitan area, 35 (87.5%) clinics were reported to have been closed for greater than or equal to 10 days. -by Mark Neumann
Source: Kidney International/ESRD Network 13