Like Fresenius, DaVita calls on its vendors to start staging supplies ahead of time whenever possible, and it has set predetermined call-in numbers and times so that the company’s national emergency-response team members can communicate with one another as well as the managers of the affected facilities. Emergency-related responsibilities are classified into approximately 100 different accountabilities.

“Our plan breaks down the needs that any one of our clinics or business offices could have,” McKenzie said. “For example, one of the responsibilities of the biomed team members is water. So they determine if the water is usable for dialysis treatment, and if it isn’t, they’re responsible for finding water and bringing it in on trucks or however they might get it there.”

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Fresenius’ Numbers calls these experts the company’s “storm chasers.” “We’ve learned over the years that we’ve got to have water-treatment people who get into those facilities immediately to eliminate problems. If you have saltwater in a dialysis system, it can take 12-24 hours to clean it out, so we’ve got to get there first and fast. The storm chasers are the first guys we send in; they have everything they need to start up the water-treatment system in a dialysis facility. And that has really been a key to why we can open our facilities faster than anybody else.”

Tracking relocated patients

At DaVita, accountability for tracking down displaced patients falls to the information technology (IT) team. “Patients can end up in our clinics or in a competitor’s clinics or in the hospital,” McKenzie said. “In some cases, we’re able to stay in touch with a patient via telephone. But if a person were to evacuate from Louisiana, go to a relative’s house in Ohio, and attend another DaVita clinic there, our system would pick that up through the person’s ID information.”

DaVita also issues patients wristbands displaying the company’s toll-free number. “We instruct them to call that number and let us know, for example, that they’re being evacuated to another city or town,” McKenzie explained. “We’ll then help them find the closest clinic and schedule them there.”

The company’s IT systems contain all the medical information for a given patient, and these records can be pulled up at any DaVita clinic in the country. If the patient ends up at a non-DaVita-operated facility, the company provides that facility with the necessary patient information.

Dr. Kopp described a similar federal system that was put in place during Hurricane Ike. Information on all evacuees who were evaluated at federal medical stations (special-needs shelters) was entered into a single, integrated electronic medical record system. The data were uploaded to a nationwide server every few hours, making it possible to track the status and location of those evacuees—all of whom had significant medical problems, including ESRD. 

At Fresenius, Numbers said, “We set up a toll-free patient emergency line and give that number to patients, particularly in hurricane zones and coastal areas. Our call center answers that phone 24 hours a day during a disaster.”

As soon as a patient calls in, the operator can provide the address and phone number of the closest dialysis center so the person can arrange to get there for treatment.

In 2008, DCA implemented its own toll-free number. A corporate staff member receives the calls, and each facility administrator then tracks his or her respective patients throughout the crisis.

In the 2007 CJASN report previously cited, the KCERC called global positioning system (GPS) devices in cell phones “an intriguing approach to maintaining contact between patients and dialysis facility staff.” The authors contended that such a system could be readily adopted by a dialysis unit to track the movements of patients—and perhaps staff—after a disaster and direct first responders to transport those in need.