Dialysis providers reopen clinics after Hurricane Florence floods the Carolinas

Debbie Cote, MSN, RN, CNN, NE-BC

As of Sept. 10, Virginia was in the direct path of Hurricane Florence. Staff began reviewing emergency plans and a 3-day diet with patients. Patients were notified to think about alternate plans to reach treatment facilities depending on where they lived. Social workers identified shelters in the area and provided that information to our patients.

Home training nurses reached out to home dialysis patients. For PD patients, we wanted to make sure anyone on a cycler was prepared to do continuous ambulatory peritoneal dialysis. Home hemodialysis patients were given options to change treatment schedules to reduce the demand for power needs at the peak of the storm.

Facilities reprinted patient orders to have the most accurate ones in case there was a disruption in our information technology. We planned to review clinic downtime procedures. We also thought about the lab courier services that pick-up specimens and bring these to the hospital laboratory.

Staff were told to prepare their own emergency plans and “go bags” in anticipation of the need to stay overnight at the clinic. We offered the facilities as a safe place to stay to eliminate travelling if needed. We also discussed the need to be operational on Sunday for patients if needed and started to prepare team members. We discussed any potential schedule changes in the clinic, but with the geographic diversity of the facilities and the unpredictable path of Hurricane Florence, we opted to leave that to the local leadership to make that decision as appropriate for their areas and conditions.

Generators were checked for fuel and to ensure function. The biomed team made sure the machines were plugged into the emergency outlets. We were prepared to provide oxygen to patients who required it, without the use of oxygen concentrators. In one facility where the medication refrigerator is not on a generator, plans were made to move the drugs to another facility for storage.  

The biomed team reached out to our water vendor in case potable water was need at a facility. We were disappointed but understood that most of the trucks were already committed to FEMA under contract. We asked the units to stock water bottles and ice for upcoming power outages and/or useable water sources. Clinics were asked to check for flashlights and batteries for use as back up if needed and to ensure emergency radios were in the unit where they could be heard and that these functioned.

The question was raised if we had a contact with the National Guard in case we needed emergency transportation. As we are hospital based, we have an active emergency management team who, in the event of a declared emergency, would open the command center and we would reach out for assistance. 

We had some concerns with supply delivery later in the week to the units, so we contacted our two main vendors for weekly deliveries to be delivered before the storm. We made plans to have windows boarded in the three facilities that have a wall of windows in the treatment area.

We were prepared for the worst, but we got lucky when Hurricane Florence took a turn to the south and the hurricane threat was gone.

Our next step is to make this a table top exercise: review with the staff to get input into things that we might not have thought of or things that we might have over-reacted to, and do an after-action review. We want to take advantage of the planning that was not needed and learn from it.