Tropical storms Fay, Gustav, Hannah, and Ike grabbed the headlines this month as dialysis providers scrambled to keep their clinics operational. But disaster management covers a multitude of emergency situations. Is your dialysis clinic or transplant unit prepared?

While the government is working on local and national pandemic preparedness plans, the dialysis industry has also started a focus of its own in preparing for disasters.

The pandemic response team, formed in March 2007, is a sub-team of the Kidney Community Emergency Response Coalition (KCER). More than 30 current team members include representatives of dialysis patient organizations, dialysis providers, ESRD Networks, governmental state and local representatives, the Center for Disease Control and Prevention, physicians, and a Canadian dialysis social worker who had first-hand experience with the severe acute respiratory syndrome, or SARS, outbreak.

KCER monitors weather-related and other disasters, and maintains information about dialysis services. KCER makes it easy to keep abreast of dialysis services during disasters through its Web site, www.kcercoalition.com. To view open /closed status of dialysis facilities go to the KCER link at www.dialysisunits.com.

At the KCER Web site, conference call minutes are posted as well as resources on pandemic preparedness for patients and families, dialysis providers and health care workers, and general information about pandemic preparedness and news releases. Additional team activities include:

  • The patient preparedness sub-team has completed an extensive patient checklist specific for pandemic preparedness which is posted on the KCER and National Kidney Foundation Web sites.
  • A document summarizing OSHA mask recommendations is posted on the pandemic response team”s Web site.
  • A pandemic planning checklist for dialysis providers is the newest resource posted to the Web site. The pandemic response team is serving as a resource to ESRD Networks and dialysis providers as they work on developing their own pandemic preparedness plans and resources for staff and patients.

The pandemic response team aims to provide information and guidance in decision-making for both patients and dialysis providers as the kidney community works to grow in knowledge and actions about pandemic preparedness. Toward this goal, the team is working quickly to provide concrete tools to both patients and providers on pandemic preparedness.

Is Ike the last?
Dialysis providers who struggled to keep their clinics open through tropical storms Fay, Gustav, and Hannah sloshed through the biggest and the baddest of them all on Sept. 12-13: Ike, which hit the Texas coastline with 115 mph winds and thunderous rain. The storm closed some 80 dialysis clinics in Houston, Corpus Christi, and surrounding towns, knocking out more than 500 dialysis stations as the state began to clean up the aftermath.

On Sept. 10, authorities in the Houston area and along the Southeast Texas Gulf Coast ordered hundreds of thousands of people to evacuate as Ike gathered strength and was heading for the coastline. Forecasters issued a hurricane warning for the Texas Gulf Coast from the Louisiana state line to near Corpus Christi.

On its way to Texas, Ike blasted through Cuba, gathering strength as it destroyed thousands of homes there.

In a memo sent Sept. 8 to dialysis facility administrators and nursing directors, ESRD Network 14 executive director Glenda Harbert suggested clinics be prepared to move dialysis patients quickly. “It is very important that you ascertain where your patients plan to go and arrange transient dialysis with affiliated facilities. Additionally evacuating staff should be sent to assist with the provision of transient dialysis whenever possible. Facilities that are not in a hurricane area but are on evacuation routes should immediately download the maps where the evacuation routes come through or near your city so you can plan for a surge in dialysis treatments that will be required.”

Jeffrey Kopp, MD, of the United States Public Health Service”s Kidney Disease Section, set up a Federal Medical Station in College Station, TX, to help direct evacuated dialysis patients from the Houston area to other dialysis clinics outside the hurricane”s path. Kopp was involved in organizing emergency dialysis treatments for Texans during Hurricane Rita.

In Galveston, the storm shut down Island Dialysis, a 27-station clinic. The majority of closed clinics were in Houston, where Texas Gov. Rick Perry urged evacuated residents a day after the storm not to return yet. About 150,000 of the 220,000 residents who evacuated ahead of the storm were still out of their homes. Power had been restored to at least 500,000 customers in the Houston area but another 1.5 million people in the state still had no electricity.

Ike and its remnants left at least 27 people dead from the U.S. Gulf Coast to the Great Lakes. Hurricane-force winds from the storm were felt as far north as Kentucky, and heavy rains flooded streets in Chicago, Deaths related to the storm were reported in Louisiana, Arkansas, Indiana, Missouri and Ohio as well as Texas.

More than 340,000 Louisville Gas and Electric Co. customers were without power Monday morning, and across the region, more than 1.3 million people were without power, the AP reported.

Other storms
Taking a more cautious approach this time, Louisiana officials ordered 1.5 million people to evacuate after Hurricane Gustav arrived there on Sept. 5. The town was spared as levees repaired after Katrina held back the water. Some industrial areas outside the town were flooded.

Florida Gov. Charlie Crist declared a state of emergency before Hanna hit the Florida Keys, as emergency officials in Georgia and South Carolina went into 24-hour alert mode. The city of Savannah hadn”t seen a direct hit from a major hurricane in more than a century.

To help health care facilities stay operational through the storms, the Centers for Medicare and Medicaid Services told state survey agencies on Sept. 2 it would “waive or modify, to the extent necessary, certain requirements, or timetables if providers, acting in good faith to provide needed forms or services, are unable to comply with the requirements as a results of the effects of the disaster.” The policy was only applicable to specified counties in Louisiana, Texas, Mississippi, and Alabama.

Assistance for patients
Several renal organizations offered to help patients with emergency funds during the storms. The American Kidney Fund”s Disaster Relief Program offers block grants to dialysis clinics to help patients replace medications, food and household items and pay for essentials, such as transportation to dialysis if they have been temporarily evacuated. The National Kidney Foundation also offered funds to help transport patients to other facilities if their own clinics were closed due to the hurricanes.

Resources to help you prepare

Renal Provider Hotlines
Fresenius Medical Care: 800.626.1297
DaVita Inc.: 800.400.8331
Dialysis Clinics Inc.: 800.969.4438

Web sites

KCER:
www.kcercoalition.com

National Hurricane Center
www.nhc.noaa.gov/

Guidance for dialysis providers on “boil water advisory”
www.cdc.gov/ncidod/dhqp/dpac_dialysis_boilwater.html

Water-related emergencies
www.bt.cdc.gov/disasters/watersystemrepair.asp

Tips about medical devices and hurricane disasters
www.fda.gov/cdrh/emergency/hurricane.html

Medical devices exposed to heat
www.fda.gov/cdrh/emergency/heathumidity.html

Medical devices requiring refrigeration
www.fda.gov/cdrh/emergency/refrigeration.html

Using potentially contaminated and temperature sensitive drugs during a disaster
www.fda.gov/cder/emergency

Flood cleanup – Avoiding indoor air quality problems
www.epa.gov/mold/flood/index.html

Storm and flood cleanup
www.cdc.gov/niosh/topics/flood

OSHA hurricane fact sheet
www.osha.gov/OshDoc/data_Hurricane_Facts/Bulletin3.pdf

Survey and certification emergency preparedness issues
www.cms.hhs.gov/SurveyCertEmergPrep/


Ms. Funk Schrag is the director of advocacy and state government affairs for Fresenius Medical Care North America and is the co-chair of the KCER pandemic response team.