Plans are in place to enable dialysis facilities to function during power outages and disruptions in water supply.

For most patients with end-stage renal disease (ESRD), local dialysis centers are a necessary component of their lives, providing crucial—even lifesaving–treatment.

But are dialysis facilities prepared for emergencies, such as power outages and disruptions in water supply, that could hamper their ability to dialyze patients? Such emergencies in recent years have prompted major dialysis chains to rethink and restructure their disaster-preparedness plans. 

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The massive blackout that struck the Northeast and other areas in August 2003 prompted Fresenius Medical Care to cast a wider emergency-preparedness net for its 1,650 outpatient dialysis clinics. “More than 100 of our facilities were affected by that power outage,” recalled Bill Numbers, vice president of operations support and incident commander for disaster response and planning for Fresenius.

“We always had disaster planning at the local levels, but [after that experience,] we decided to do it at a more comprehensive, centralized level.”

With the lessons of the blackout fresh in their minds, Fresenius’ first disaster-planning team was born. Numbers and his colleagues crafted procedures for handling future widespread power outages as well as a range of other emergencies—those that come with warning and those that do not. “We developed a plan for nuclear-plant failure, earthquake, ice storms and snowstorms, floods, and hurricanes,” Numbers said.

The catastrophic 2005 hurricane season featuring Katrina, Rita, and Wilma put a large segment of the kidney-care field to the preparedness test—and it failed, according to Jeffrey B. Kopp, MD, and the other members of the Kidney Community Emergency Response Coalition (KCERC). The coalition was formed in January 2006 by representatives of more than 50 government agencies and private organizations to address nephrology-related emergency planning and response needs.

“Hurricane Katrina and its aftermath was a message to the community of kidney patients and their providers that every patient, care provider, and dialysis facility needs to have a plan in place for disasters—and needs to practice these plans and revise them as knowledge of best practices improves,” said Dr. Kopp, staff clinician, Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). He also is a commissioned officer with the U.S. Public Health Service.

In a report published in the Clinical Journal of the American Society of Nephrology [CJASN] (2007;2:825-838), Dr. Kopp and his KCERC collaborators outlined key recommendations for nephrology providers, patients, and emergency personnel at the federal, state, and local levels.

For example, providers are urged to make an emergency plan, which in part entails procuring and maintaining emergency equipment and supplies, planning the evacuation of patients and staff, and creating a list of emergency telephone numbers that will allow them to communicate with each other. Many of the recommendations for dialysis facilities are echoed in the requirements set forth in the federal final rule on emergency preparedness for dialysis facilities.

Providers should also help patients keep updated lists of medication and dialysis-treatment information and prepare them for an emergency. 

Yet Dr. Kopp remains concerned that relevant medical information for patients is not efficiently and rapidly made available to the special-needs shelters and dialysis facilities that must care for these individuals.

“We saw after Hurricane Ike [which made landfall in Galveston and Houston, Texas, in September 2008] that dialysis facilities in surrounding areas were able to promptly absorb evacuees who needed dialysis treatment,” Dr. Kopp said.

“Nevertheless, evacuees frequently arrived at special-needs shelters without a health information packet, which provides information about their dialysis prescription, medication, estimated dry weight, and medical problems, including viral infection status. Without such information, it was difficult to provide these patients with optimum care.”