Recent wildfires, hurricanes test kidney care disaster response
Extreme weather and climate disasters pose particular dangers for patients with chronic kidney disease who are dependent on dialysis.
Whether they need to leave their home, patients may experience treatment interruption, loss of health care providers, lack of appropriate food and clean water, and increased infection risks. Health care providers may encounter damaged facilities and infrastructure, supply shortages and sicker patients — all while dealing with personal stressors, concerns for coworkers and burnout.
On Jan. 7, wildfires broke out across the Los Angeles area causing widespread destruction of homes and other buildings, including health care facilities. A week later, about 88,000 people were under evacuation orders with 84,000 on standby for evacuation if the fires spread, according to The Associated Press. Power outages affected more than 100,00 homes and drinking water in many areas was deemed unsafe.
Danilo B. Concepcion, CBNT, CCHT-A, FNKF, operations manager for renal services at Providence St. Joseph Hospital in Orange, California, lives in Chino Hills. Although his home was about 30 miles from the nearest fire when he spoke to Healio | Nephrology News & Issues, his power was turned off and his family was packed and prepared to evacuate if necessary. His area had received at least one evacuation alert in error.
“We are so accustomed to these situations that we talk to our patients about them and inform them of what is going on,” Concepcion, who is also a Healio | Nephrology News & Issues Editorial Board Member, said. “We try to maintain that emergency preparedness mentality.”
For patients on dialysis, he said, “there is such a concentration of dialysis facilities throughout Southern California that if you are in an affected area, it may be difficult, but it is doable to go to an affiliate-agreement place to receive your dialysis. The only thing that would impact patients is if they themselves are in the immediate area where they have had to evacuate, and that is something we do not have a number on, because it is happening so quickly.”
When asked what single thing would help patients on dialysis currently affected by the wildfires, Scott E. Riddell, national deputy incident commander at Fresenius Kidney Care, told Healio | Nephrology News & Issues: “In addition to improvements to air quality, community support is critical to our vulnerable patients. Among each other, our patients reinforce the importance of continuing to attend dialysis treatments during a disaster. But the additional support of friends and family to help dialysis patients overcome obstacles, like transportation cancellations, emergency evacuations and city-wide power outages, is invaluable.”
Preparation is key
Emergency plans and disaster recovery processes are regulated for health care facilities that receive federal funds. Staffers review plans regularly and drill, so they are as prepared as possible for such events, according to Thomas C. Crook, MT, CEO at Mountain Kidney & Hypertension Associates PA, in Asheville, North Carolina.
In September 2024, Crook was in the process of reviewing the disaster recovery processes when Hurricane Helene hit and devasted his community (see sidebar here). He said he felt as prepared as possible.
“If it were to happen again today, I honestly do not know that I would do anything differently,” Crook told Healio | Nephrology News & Issues. “When you look at the fires in California ... how do you prepare for everything completely being destroyed? You can have all your contingency plans, but if your contingency people lost their buildings too, it does not work.”
Health care companies with large footprints in kidney care are able to prepare on a larger scale.
“In the case of the current wildfires, as part of our preparation we had air scrubbers available in high concentration areas, which were put to immediate use. We also had N95 [masks] on hand. This is a credit to our advanced preparation, which has ensured critical resources are available to our patients a moment’s notice,” Riddell said. “In areas more prone to extreme weather events, we also equip many of our clinics with generators to ensure energy continuity.”
Maintaining communication with patients and providers is essential, according to William G. Paxton, MD, PhD, vice president of medical affairs at DaVita.
“Even before storms make landfall, [emergency response] teams are activated to monitor anticipated impact and initiate outreach to patients to discuss ... diet plans, dialysis scheduling, resources to find open centers and more,” Paxton told Healio | Nephrology News & Issues. “This proactive approach helps alleviate uncertainty for patients. It also provides clarity for them to make informed decisions.”
During Hurricanes Helene and Milton, DaVita was able to provide generators, water tankers and fuel to keep affiliates operational.
“[Our] ability to mobilize swiftly and efficiently in collaboration with neighboring physicians and providers, as well as state regulators and officials, made a critical difference in maintaining access to care for patients on dialysis. ... Within 4 days of each storm’s landfall, 99% of centers in North Carolina and 100% of centers in Florida that experienced closures were open and operational,” Paxton said.
For patients, tips and checklists for emergency preparedness are available from several organizations, including the CDC, National Kidney Foundation and American Kidney Fund.
Concepcion is a co-author of the emergency preparedness guide for people on dialysis that is issued by CMS. His organization developed a video that all staff members and patients review regularly.
“We are in a state where it is not just fires but earthquakes. We have to be prepared. Emergencies tend to be local, so we all have our own specific plans of what needs to be done and who to contact,” Concepcion said. “You can drill as many times as you want, but when the real thing occurs, there will still be gaps that you did not think about or people who will not behave like what you did in a drill. But the more you drill, the more it becomes real, and hopefully, you all react better. People who complain about drills should not.”
Lessons for future events
Disasters can have impacts beyond their immediate time and place.
“The impacts span a larger geographic territory, so we have begun initiating disaster response at broader levels to encompass not just those directly impacted but also surrounding areas,” Riddell said. “In many cases, this includes opening our facilities to all in the dialysis community — not just our own patients.”
“As we look to the future, our focus is on supporting patients and teammates who have experi-enced unimaginable loss and hardship,” Jeffrey Giullian, MD, MBA, chief medical officer for DaVita, told Healio | Nephrology News & Issues. “For some, that means finding long-term shelter. For others, it means emotional support and connections to vital resources. We are, and must be, more than a company in moments like this: We are a community of caregivers working to meet every person where they are and to serve their needs to the best of our ability.”
Baxter International, the largest manufacturer of peritoneal dialysis and IV solutions in the United States, lost its manufacturing plant in North Cove, North Carolina, to flooding after Hurricane Helene, causing shortages of essential supplies throughout the country. The company worked with several federal agencies to devise and distribute recommendations for substituting and conserving existing supplies and obtained waivers to import supplies.
Baxter expects to recover to pre-hurricane production levels in the first quarter of 2025, but distribution chains will take more time to recover, according to a Dec. 19, 2024 press release, which is the most recent.
Crook noted the lasting mental health effects of disaster survival.
“One of the things that was probably most difficult for us was the emotional impact,” Crook said. “Everybody here still has PTSD from this.”
Key to recovery is to “hold meetings and do things that bring people together. They have been through this by themselves with their family. Now they are in front of thei,r families at work, and they need time to decompress and just kind of get back to normal.”
- References:
- The Associated Press. California wildfires: Updates from Jan. 14, 2025. Available at https://apnews.com/live/los-angeles-california-wildfires-updates-1-14-25. Published Jan. 14, 2025. Accessed Jan. 14, 2025.
- Baxter. Hurricane Helene Updates. Available at https://www.baxter.com/baxter-newsroom/hurricane-helene-updates. Published Dec. 19, 2024. Accessed Jan. 14, 2025.
- CDC. Disruptions in availability of peritoneal dialysis and intravenous solutions from Baxter International facility in North Carolina. Available at https://www.cdc.gov/healthcare-associated-infections/bulletins/shortage-of-iv-and-peritoneal-dialysis-solutions.html. Published Oct. 30, 2024. Accessed Jan. 14, 2025.
- CMS. Preparing for Emergencies: A Guide for People on Dialysis. 2023. Available at https://esrd.ipro.org/wp-content/uploads/2023/03/CMSPreparingforEmergencies_508-compliant-_updated-3.2023.pdf. Published March 2023. Accessed Jan. 10, 2025.
- For more information:
- Danilo B. Concepcion, CBNT, CCHT-A, FNKF, can be reached at danilo.concepcion@stjoe.org.
- Thomas C. Crook, MT, can be reached at tcrook@mtnkidney.com.
- Jeffrey Giullian, MD, MBA, can be reached at jeffrey.giullian@davita.com.
- William G. Paxton, MD, PhD, can be reached at william.paxton@davita.com.
- Scott E. Riddell can be reached at scott.riddell@freseniusmedicalcare.com.
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