We're all aware of the importance of planning for emergencies in our dialysis facilities. CMS' proposed new rules re-emphasize the critical value of a comprehensive approach to emergency preparedness and response that ensures continuity of care for dialysis patients.1

To help ensure the health and safety of patients during and after emergencies, it is important that dialysis facility leadership, direct care staff, clinicians, patients, and family members all understand their roles and individual responsibilities in planning and implementing emergency management strategies.

A comprehensive approach to emergency planning takes into account the variety and breadth of emergencies that could impact the operation of a dialysis facility or the ability of patients to have access to dialysis treatments. A look back over the recent past clearly demonstrates that emergencies can be as dramatic as the West Virginia chemical spill in January 2014, or the Boston Marathon bombings that closed down the city for several days in April 2013, or as commonplace as a local power outage.

These emergencies can seriously affect dialysis patients and providers. Having an effective plan that clearly defines each individual's role will help ensure that everyone acts quickly and makes adjustments to address the unique issues of the emergency at hand.

First step: Build an emergency management plan

The ESRD Conditions for Coverage mandate that dialysis facilities and staff have emergency management plans in place. On their own, these plans will be ineffective if patients aren’t made aware of and staff members aren’t routinely trained in their responsibilities. The confusion that typically accompanies an emergency is minimized when everyone involved is clear about his or her responsibilities.

Approaching an emergency situation with an understanding of your role and how it fits into the overall plan decreases the confusion and chaos of the emergency, supports better coordination, and allows you to address unexpected situations, should they arise. This holds true whether you’re a clinician, a direct care staff member, or a patient. These role-based assigned responsibilities prevent duplication of efforts, so, for example, the facility is assured that one person, and not five people, calls 911. Each individual acts as a piece of the puzzle to form a comprehensive plan that helps to ensure patient safety.

Every facility's emergency management plan should include the provision of ongoing and consistent communications messaging and the distribution of materials to patients as well as staff. Facility staff should encourage patients to:

  • Create their own emergency management plans.
  • Maintain an easy-to-access list containing contact information for their physicians and their dialysis facility.
  • Create a list of the supplies needed for an emergency renal diet.
  • Keep at least one week's supply of products on hand.
  • Provide their facility with current contact information at all times.
  • Maintain communication with their facility in the event that their appointment(s) need to be rescheduled or if alternate treatment locations have been designated during an emergency.
  • Keep in contact with their physicians during an emergency in order to allow monitoring of adverse reactions, should there be a disruption of dialysis treatment.

A comprehensive emergency plan requires that facilities establish multiple ways to maintain a dialog among the patient, physician and dialysis facility, as well as a plan to report facility open/closed/interruption of service status to the state health department and the jurisdiction’s ESRD Network. Contact information for physicians, dietitians, suppliers, alternate facilities, utility companies and other community stakeholders should be updated on a regular basis and re-circulated to key members of the staff, both electronically and in hard copy. In addition, both patients and staff members should be encouraged to identify alternate transportation options, should they need them.

Four phases of emergency management

All ESRD stakeholders should be working with a standardized definition of emergency management to facilitate comprehensive and uniform planning. This definition features four phases which, when combined, produce a complete emergency plan.

Pre-emergency

1.  Mitigation: These activities eliminate or reduce the probability of the event, or reduce its severity or consequences. An example of mitigation activities would be the installation of a generator, and the development of processes to ensure that adequate supplies for the operation of the generator are always on hand and that the generator is properly maintained.

2.  Preparedness: This phase includes activities to ensure that procedures, programs and systems to handle the emergency are developed and implemented. For a patient this might include developing of a contact and medical information file and evacuation plans, as well as stocking emergency renal diet supplies.

Post-emergency

1.     Response: When the incident occurs, the Response Phase kicks in with measures designed to address the immediate and short-term effects of the disaster or emergency. This is the phase when first responders are called to action.

2.     Recovery: In this phase, activities and programs are implemented to return conditions to a level that is acceptable to the entity. Also known as the “new normal,” the Recovery Phase may take hours, days or years, depending on the severity of the incident.

Key points for staff to remember in planning for emergency situations

  • Know the contact information for your ESRD Network and your state health department.
  • Know your state and local regulations.
  • Manage. Don’t react—take control.
  • The more effectively you manage, the more efficiently you’ll be able to mitigate the emergency.
  • Review and revise the facility emergency plan regularly (especially after a disaster).
  • Implement a standardized planning approach to help ensure effective communications with all stakeholders.
  • Maintain communications with those community stakeholders with whom you have established relationships. Serve as a resource to your community.
  • Create and update your personal emergency plan. As a health care provider, the more effectively you manage your own safety, the more available you will be to care for your patients.

KCER and your ESRD Network

As part of the ESRD Network Coordinating Center, the Kidney Community Emergency Response (KCER) program supports ESRD Networks in disaster planning and response by coordinating resources and sharing information with the Networks, providers,‹ and other associated stakeholders. This emergency management approach is designed to report the unfolding events clearly and concisely and to provide strategies to minimize negative health effects to the ESRD patient. Under the direction of the Centers for Medicare and Medicaid Services, the KCER team coordinates emergency activations, educates on best practices in emergency management, encourages development of stakeholder relationships, and shares safety alerts. KCER committees support specific critical ESRD topics, including clinical, education and staffing needs, working to enrich preparedness and response methods for the community. For more information, visit www.kcercoalition.com/

How ESRD Networks help

Each of the 18 ESRD Networks supports the facilities in their own region in improving the quality of health care services and quality of life for ESRD beneficiaries. The ESRD Networks are charged with supporting providers and, in turn, patients in emergency situations. Each Network has emergency management plans and procedures, as well as continuity and contingency plans in place to ensure that redundancies are in place to sustain its business operations during an emergency or disaster. The Networks disseminate important information to the providers in their regions, and gather data to determine the scope of a disaster and the effects on the ESRD patient population. Networks also assist in developing plans to provide alternate treatment options. For more information, visit http://esrd.ncc.org.

Conclusion

Every member of the ESRD community requires personal and organizational preparedness plans to support the larger community in a crisis. Resiliency and relationships among the individual stakeholders is key for an alert and educated community to effectively withstand the effects of a disaster. It is critical for all ESRD stakeholders to develop personal preparedness plans and then overlap those plans with those of their ESRD organization.