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Disaster Preparation for Peritoneal Dialysis Programs

Article published in PDServe Connection Vol 9, No 3, 2005

 

Disaster Preparation for Peritoneal Dialysis Programs

 

Debra Lanham McClure MPH, RN, CNN

 

Few circumstances can create fear like a natural disaster. Frustration from loss of control as one waits for the event to conclude can result in an inability to act when needed.  This feeling can be even more acute for those with chronic kidney disease requiring dialysis.  Schedules are disrupted in the clinic due to shifting demands for resources, such as transportation, personnel, and utilities.  For the home self-care patient, it may bring a sudden change in modality and isolation from resources; evacuation may become necessary.  All home patients must be prepared for natural disasters in order to effectively provide self-care and there are several resources to assist patients and providers in planning.

 

Natural disasters come in many forms, often a factor of locale.  Those who reside near the oceans are more prone to threat from hurricanes and tsunamis, those who live along geographic fault lines are more exposed to earthquakes, and blizzards are more common in northern climes.  Other natural threats such as wild fires may occur anywhere and may impede evacuation by usual routes.  Some natural disasters can be anticipated and have advanced warning; others come surreptitiously.  High winds, tornadoes, floods, and severe lightening can come at any time and may disrupt utility services that may negatively impact home self-care patients.  Home patients must know what types of events can disrupt their ability to dialyze and how to prepare themselves with alternate plans to avoid interference of their self-care.  Since disaster preparations are much more complex for home hemodialysis patients, we will confine this discussion to peritoneal dialysis (PD) patients.

 

According to the National Oceanic and Atmospheric Administration (NOAA) website, the predictions for the 2005 Atlantic hurricane season are to have above-normal activity atop the crushing 2004 season from which many have yet to recover.  NOAA predicts 12 to15 tropical storms (maximum sustained winds of 35 - 73 mph or 63 – 118 km/hr), with 7 to 9 expected to develop into hurricanes (maximum sustained winds of at least 74 mph or 119 km/hr), three to five of which could be major hurricanes.

 

Health care providers can easily stay abreast of predictions, changing weather systems, and recommended actions via the Internet and the National Weather Service (NWS) Emergency Broadcasting System.  Many reliable weather-related websites are sponsored by both governmental and commercial entities.  Some websites even offer a number of products to keep one alert to changing weather threats by transmitting directly to your portable digital assistant (PDA), or wireless application protocol (WAP) cellular phone. Websites for Emergency Management Services for each state can typically be accessed through a main web page for state government services.  One example is the website for the Florida Division of Emergency Management (FDEM) at  http://www.floridadisaster.org/eoc/index.htm. This website contains online links to other agencies such as the National Hurricane Center, a listing of all county emergency management offices, recommendations for family preparedness, emergency shelter operational status, and direct online communication capability with FDEM, and additionally, there is information about terrorism threats.  One can easily search for similar websites in their local area. Healthcare providers should designate specific staff members to check websites or local weather sources daily during hurricane season to avoid surprises.  The NWS provides an Emergency Broadcasting System for regional and local weather-related emergencies.  This signal typically broadcasts to emergency weather-band radios and selected participating commercial radio and television stations.

 

It is critical in emergency planning to know what types of hazards may present problems and to define the threats that can be anticipated.  A good reference to dialysis providers is available on the Internet from www.cms.hhs.gov called “Emergency Preparedness for Dialysis Facilities: A Guide for Chronic Dialysis Facilities”.  This document advises providers of their obligations under the Medicare Program (United States), and discusses the various phases of mitigation and response planning for natural disasters such as fires, tornadoes, hurricanes, floods, severe winter weather, and earthquakes. Additionally, this document addresses other types of threats such as biological hazards, bombs, workplace violence, and civil disorder.  This publication provides concise direction for self-assessment of hazards, mitigation, and plan development, as well as tools for completing or reporting assessments that may facilitate recovery or reimbursement for expenses related to operation during disasters.

 

A companion piece developed to educate patients about disaster planning is also available from the CMS website at http://www.medicare.gov/Publications/Pubs/pdf/10150.pdf.  The document “Preparing for Emergencies: A Guide for People on Dialysis” discusses the potential for disruption of dialysis services due to circumstances beyond control and advises patients of simple preparation that can facilitate survival and self-reliance.  Communication with facility staff and awareness of threats to health and safety are the key goals of the publication.

 

Beyond providing written instructions to patients on emergency preparations, home therapy nurses should review with their patients disaster preparedness plans annually.  In Florida, where the threat of hurricanes exists six months per year, we review information and technique with our patients in April or May so that all preparations are in place by the arrival of the Atlantic hurricane season on June 1st. The disaster action plan for our program includes the following steps (performed and documented annually):

 

  • Obtain updated contact information (address, main phone number, cell phone number, emergency contact name and phone number) and document in medical record and on any emergency phone lists utilized by the clinic.
  • In areas where flooding or hurricane evacuations may be possible, ask the patient to identify his/her residence on an elevation map or hurricane evacuation map.  It is important for patients to know their level of risk in developing an emergency plan.
  • All patients should have a specific disaster plan identified and shared with clinic personnel that include at least the following elements: 
      • Evacuation level of the residence and shelter site to be used if evacuated
      • Contact numbers for local emergency management and shelter locations
      • Location of friends or relatives in other locations that may serve as an evacuation site from the primary residence
      • Emergency contact information to reach dialysis clinic personnel after a storm
      • Community-wide emergency plans that have been developed by the renal community should be shared in writing with all patients
      • Re-location plans for the dialysis clinic if it is in an evacuation zone
      • Phone numbers for PD products supplier
      • Emergency food and water for a minimum of 4 days for all (humans and pets) who will be housed during the event
      • Medications for at least 7 days [for all members of household, as applicable]
  • All patients undergoing automated PD (APD) should demonstrate proficiency in performing manual exchanges (CAPD). When electrical power is not available, the cycler will not work so all patients must be ready to switch to manual exchanges based on weather conditions and availability of utilities. Strong summer thunderstorms, wild fires, tornadoes, tropical storms, hurricanes, floods, and winter storms all have the potential to disrupt utility service. Patients must be fully prepared to perform manual exchanges until electrical power is restored.
  • All PD patients should check the status of their manual supplies to assure the following:
      • A supply of manual exchange equipment for a minimum of 7 days of CAPD
      • All expiration dates are good through November (this will take a patient through hurricane season which ends November 30th)
      • A selection of dialysate concentrations (e.g., 1.5%, 2.5%, and 4.25%)
      • Clearly marked boxes for manual supplies to make them easily recognizable and easy to pack in case of emergency evacuations
      • Extra universal connector and catheter extension set for emergencies

 

A calm and well-organized approach to disaster planning will assure that healthcare providers are in a position to continue services in spite of external threats.  It is never too late to develop a facility disaster plan.  Personnel will be better able to develop their own personal emergency plans knowing their part in the dialysis facility’s plans.  Managers should be cognizant of social issues that may impact the availability of staff members and have contingency planning that accounts for the responsibilities of single parents with young children or aging parents; those who are involved in community emergency planning (as volunteers), who may be called from your clinic to serve the greater community during a disaster; or those who are in military reserves or National Guard units who may be called suddenly to active duty.

 

When there is time in advance to prepare, as there is with an approaching hurricane system, managers should also consider timing.  What time of the month is it?  Is it nearly payday?  Will your staff be able to manage without paychecks?  How many staff are scheduled for vacations?  Is your monthly billing ready to submit to insurers? Are your computer systems protected from losses of data and protected from the elements?  Cash is always needed after an emergency as bank automated tellers and the like will be non-operational and many vendors will turn to “cash only” sales.  Brainstorming through the “worst case scenario” will allow the healthcare team to identify potential hazards and threats and recognize resources.  Develop an emergency plan as a team to allow input from several critical areas (e.g., administrative, clinical, physical plant, and human resources) and prevent inadequate plans.  Our patients depend on us to survive; by identifying threats and developing contingency plans, we can help them to continue in their independence and self-care.

 

References:

 

  1. Centers for Medicare and Medicaid Services, Department of Health and Human Services, Emergency Preparedness for Dialysis Facilities: A Guide for Chronic Dialysis Facilities. Revised 2/20/03. Publication Number: CMS-11025. Available through link at www.cms.hhs.gov/providers/esrd.asp
  2. Centers for Medicare and Medicaid Services, Department of Health and Human Services, Preparing for Emergencies: A Guide for People on Dialysis. Publication Number: CMS-10150. Available at www.medicare.gov/Publications/Pubs/pdf/10150.pdf
  3. Florida Division of Emergency Management. Florida State Emergency Response Team. Available online at www.floridadisaster.org/eoc/index.htm
  4. National Weather Service, National Hurricane Center Tropical Prediction Center. NOAA issues 2005 Atlantic hurricane season outlook: Another above normal season expected. Retrieved on June 1, 2005 from www.nhc.noaa.gov/

 

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