“Always evacuate”

If you’re a Fresenius patient, you will always be urged to evacuate when a hurricane threatens. “A dialysis patient may think, ‘I can’t evacuate because I won’t get dialysis,’” Numbers said. “We educate them all [so they know] that isn’t the case. They should want to evacuate because then we can take care of them. It’s much harder when people don’t evacuate to try to keep a dialysis center open.”

Case in point: When Hurricane Gustav blew through Louisiana late last summer, people evacuated because of the Katrina experience. “And it was not a very bad situation, dealing with all those evacuated patients, because they went to locations where facilities were open, water was working, and power was up, and they were fine,” Numbers related.

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“Contrast this with Hurricane Ike, which came through Texas—Galveston in particular. Patients did not have the same recent Katrina experience, and some didn’t evacuate because they thought they needed to be near their dialysis facility.” In Beaumont, Texas, the mayor called for evacuation, but 17 Fresenius patients stayed. “That’s a problem for me,” Numbers admitted. “My choice is, get them out of there somehow or support them there. That’s a decision I need to make at the time: Do I have enough resources to go in and open dialysis facilities in an evacuated town where nobody should be?”

Providing for employees

When Numbers and his team decided they could open the Beaumont dialysis facilities, they had to arrange for generators and the diesel fuel on which they run, generators for the homes of employees and gas for their cars (because the gas stations had no power), as well as food and ice for them. Numbers also had 30 recreational vehicles sent for staffers who had come from elsewhere to Houston, Galveston, and other affected regions to help out. “We had about 100 people on site within 48 hours of the storm.”

Approximately a third of those people were security personnel. “They’re a very important part of our program,” Numbers reported. “When you open a dialysis facility in a mostly evacuated town that has no power and no water and you’re handing out gasoline and generators, food, and ice, you are a target because you’re the only light on in the neighborhood. I want my staff to feel safe when they come to work, so I station guards at all those locations. We typically use armed guards, and they make it known visibly that they’re securing this dialysis facility.”

Physicians can—and do—help

DaVita’s McKenzie admitted that it can be a challenge to get clinic staff in certain regions to devote the needed time to advance emergency planning. “We get a lot of attention in Florida, Louisiana, Texas—states that have had major problems over the last few years– and we are much more thoroughly prepared at a local level. But sometimes it’s difficult in other states to get people’s attention about disasters that they’ve never experienced. We continue to train, education, and become more prepared nationally.”

Nevertheless, McKenzie and Angie Kurosaka, BSN, RN—McKenzie’s emergency-management team colleague and DaVita’s vice president of operational support—are quite satisfied with physician response to their efforts. “Our physicians want to know what the plan is and how we’re taking care of the patients,” Kurosaka said. “They are very aware and interested.”

According to Kurosaka, the medical director at each DaVita dialysis clinic works with the local team in preparing emergency plans and instructing patients to pack a three-day diet (in case they’re unable to obtain dialysis) and all their necessary supplies. After the event, the doctors are willing to help locate patients and have an interest in knowing where their patients are. “In my experience after hurricanes Katrina and Rita, the physicians were very involved and actually assisted us in finding patients. They wanted to know the patients were safe.”

Numbers, too, had high praise for the nephrologists he has worked with during emergencies. “I’ve found the physicians in these disaster situations to be phenomenal. They show up instead of running away—they come to the disaster zone, they come to the dialysis facility, they come to their office, they come to the hospital.”

In turn, the nephrologists can gas up their cars at the Fresenius staging area so they can continue to tend to patients when gas is otherwise unavailable or avail themselves of other supplies. Numbers and his team stay in touch with the physicians regarding how many shifts the dialysis clinic will operate, how the water-treatment system is functioning, and other such issues.