Critical needs

Fresenius’ Numbers and his disaster-planning team identified three necessary elements that were missing during the 2003 blackout: the ability to bring in additional generator power to the affected dialysis facilities, a well-established communication process for Fresenius staff, and a plan for communicating with patients.

The first problem was solved easily. With Fresenius building 50-100 dialysis facilities a year, the company always has generators ready for new construction. “So now we’ve coordinated with the generator company to build some of those generators ahead of time and station them in their depots in advance of our construction needs,” Numbers explained. “That way, we have available at any moment 5-20 generators that we can call on in event of an earthquake, flood, hurricane…whatever.”


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Next on the agenda was setting up a company-wide disaster-response team to carry out the procedures developed by the disaster-planning team. Members were recruited from every department of Fresenius. The team would be activated to help handle events that affected three or more Fresenius dialysis clinics; anything less was largely a local issue.

In an emergency situation, the first step—and what Numbers called a key to the disaster-response team’s success—is having team members find a way to phone in for the conference call that takes place each day at noon Eastern time during a crisis. They have learned that even when landlines are down and cell phone networks are too full, text messaging via cell phone or BlackBerry usually remains operational, as do satellite phones and the two-way walkie-talkie capabilities of Nextel cell phones. Police stations and firehouses often will share their working phone lines with Fresenius employees needing to get on the daily conference call.

“We’ve been very successful with every single disaster, even Katrina, in that the locally affected managers were on those calls at 12 noon telling us what they needed,” Numbers said.

Dr. Kopp credited such regular conference calls with hastening the identification and resolution of patient and facility needs during one recent disaster. “The KCERC instituted a daily conference call during Hurricane Ike to coordinate responses,” he recounted. “A wide variety of people participated in the calls, including personnel from the Centers for Medicare & Medicaid services and its 18 nationwide ESRD Network organizations; nephrologists; nephrology nurses; dialysis unit directors; representatives from large dialysis organizations; vendors of dialysis-related equipment and supplies; and representatives from transportation companies.” 

During these calls, the ESRD Network for the storm-ravaged region informed dialysis providers about how many people had called seeking a dialysis unit that could treat them. Nearby dialysis units described their capacity to accept additional patients. Affected dialysis facilities stated their needs, and call participants offered their expertise and assistance.

“The call was instrumental in ensuring that dialysis facilities could cope with the influx of new patients and could reopen quickly if they were shut down,” Dr. Kopp said. In addition, “The regularity of the conference call served as a dependable line of communication that was enormously reassuring to the affected facilities.”

Dr. Kopp noted that the calls helped various ESRD Networks develop relationships that made it easier to help one another in emergency situations. He hinted that even more help might be available in the future. “The National Disaster Medical System is considering plans to form nephrology response teams that would be available to supplement dialysis facilities in need of additional staff and possibly to provide dialysis treatments in federal medical stations.”

Address employees’ needs

The daily conference calls help establish not only the needs of a given dialysis clinic but the more personal needs of the clinic staff. As a resident of Orlando, Fla., Dave McKenzie, a divisional vice president for dialysis provider DaVita and a member of DaVita’s emergency-management team, has seen firsthand how important it is to assist employees who reside in a disaster area.

“After living through the four major hurricanes that hit Florida [during a six-week period] in 2004, I learned how crippled the people on the ground can be because they’re so focused on their families, their homes without a roof, no food, no water, no fuel, no school for the kids….There’s got to be support coming in to help the teammates at ground zero so they can then help the patients.”

DaVita operates more than 1,400 outpatient dialysis clinics nationwide, and hurricanes have been the most common trigger of the company’s emergency response. “Even with floods, mudslides, or fires, the affected area is typically smaller than with hurricanes, where 50 clinics can be out for a long time over a fairly large geographic area,” McKenzie said.

In fact, 2005’s Hurricane Katrina was the impetus for the present-day emergency plans created by DaVita. “I think it absolutely was the magnitude of that event and what we learned from it as far as the need to be more prepared,” McKenzie said. “But we’re continually updating as we experience events, whether they be hurricanes or floods or the fires in California.”

Emergency plans at another dialysis provider, Dialysis Corporation of America (DCA), are more focused on snowstorms than hurricanes because most of its clinics are located in the Northeast. DCA employees, however, are well prepared for whatever comes their way, says Joanne Zimmerman, RN, a certified nephrology nurse and vice president of clinical services at DCA. “Each facility has DCA disaster procedures that are followed and practiced quarterly,” Zimmerman noted.

“The facility administrator and medical director manage each facility individually so emergency plans are tailored to meet that center’s unique needs. The medical director of the facility serves as the director for any emergencies.”