A local feel

In addition to emergency preparedness at the corporate/national level, the dialysis facilities of Fresenius, DaVita, and DCA all have individual plans. “One cookie-cutter process does not work for all facilities,” Zimmerman pointed out. “DCA is in seven states, and even within those states, the emergency plans vary due to locality, weather, and medical director.”

These plans cover such details as where outside the facility staff members should meet in the event the facility is evacuated and which radio or television station patients should tune into in the event of an impending storm that could require closure of the facility.

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Whatever the scope or nature of an emergency, DaVita’s Kurosaka has a one-size-fits-all piece of advice: “Preparation is the key in disaster planning. Regardless of the disaster, prepare, prepare, prepare—and then when you think you’re prepared, do a little more.”

Calming Patients in an Emergency

Jeffrey B. Kopp, MD, of the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, reiterated the Kidney Community Emergency Response Coalition’s tips for fostering the emotional well-being of patients during a crisis. Reassure your patients by emphasizing the following points:

  • Despite current hardship, things will improve.
  • Experts are working together to solve problems.
  • Information will be shared as it becomes available.
  • Facility staff members genuinely care about patient welfare.
  • Evacuees retain control over certain key aspects of their situation: mental attitude, interactions with others.
  • Grieving is a normal response to disaster.
  • There is a degree of normalcy amidst the chaos.

Source: Clin J Am Soc Nephrol. 2007;2:825-838.

The Government Weighs In

On April 15, 2008, the Centers for Medicare & Medicaid Services issued its final rule on conditions for coverage for end-stage renal disease facilities, including a requirement that staff be able to manage emergencies likely to occur in the facility’s geographic area. The list of emergencies for which dialysis facilities must be prepared include but are not limited to fire, equipment or power failures, care-related emergencies, water-supply interruption, and natural disasters likely to occur in the facility’s geographic area. Among other requirements, dialysis facilities must:

  • Provide appropriate training and orientation in emergency preparedness to the staff. The training must be provided and evaluated at least annually.
  • Provide appropriate training and orientation in emergency preparedness to patients, including who the patient should contact during an emergency.
  • Provide an alternate emergency phone number if the phone is not being answered and/or the facility is not functioning during a disaster.
  • Have a plan to obtain emergency medical system assistance when needed.
  • Contact their local disaster management agency at least annually to ensure the agency is aware of the dialysis facility’s needs in the event of an emergency.

In the event of a disaster or emergency, the dialysis facility must make every effort to contact the patient’s physician prior to initiating dialysis in a special-purpose dialysis facility. The special-purpose facility is responsible for communicating with the patient’s permanent dialysis facility regarding the patient’s status, forwarding this information within 30 days if possible.

Source: Federal Register Vol. 73, No. 73, FR Doc. 08-1102 (www.cms.hhs.gov/CFCsAndCoPs/13_ESRD.asp, accessed Dec. 12, 2008).

Click here to see a video of Fresenius Medical Care’s response to Hurricane Ike.