Emergency Preparedness for Dialysis Facilities: Ensuring Patient Safety and Continuity of Care During Natural Disasters

Natural disasters can strike unexpectedly, and for dialysis facilities, being prepared is critical. Patients with end-stage renal disease (ESRD) rely on regular treatments to survive, making these facilities especially vulnerable during emergencies. In this blog post, we’ll dive into the importance of emergency preparedness for dialysis centers and explore essential strategies to protect both patients and staff. The following audio excerpts are taken from a recent episode of Taking Healthcare by Storm featuring Yessi Cubillo, a seasoned expert in patient engagement and regional emergency preparedness, who will share valuable insights from his years of experience helping facilities navigate crises.

What are the most common disasters that dialysis facilities should prepare for?

The key to effective disaster preparedness in dialysis facilities is collaboration and tailored planning. Don't look at the most common accross the board, look at what's most common in the localized region. By conducting a hazard vulnerability assessment and working closely with local emergency management, facilities can identify the most relevant risks to their area. This ensures that plans are not only comprehensive but also practical and responsive to real threats, creating a sustainable approach to safeguarding patient care in times of crisis.

Why are dialysis facilities particularly vulnerable during natural disasters?

The vulnerability of dialysis facilities during natural disasters cannot be overstated, given the fragile nature of the patients they serve. The critical need for continuous treatment makes any disruption a matter of life and death. By clearly understanding the potential consequences, it becomes evident why strong collaboration between emergency responders and dialysis facilities is essential. This urgency underscores the importance of thorough preparation to ensure that life-saving treatments can continue, especially in the face of any disaster.

What are some of the basic components needed to create an emergency preparedness plan for dialysis facilities?

STEP 1: Meet with Local Emergency Teams

The foundation of any emergency preparedness plan for dialysis facilities begins with establishing strong communication and partnerships with local emergency response teams. As highlighted earlier, dialysis patients are extremely vulnerable, and missing even a few days of treatment can be fatal. This makes it critical for facilities to communicate the life-saving importance of uninterrupted dialysis treatments to local emergency services, such as the police department, fire department, and office of emergency management. By doing this, emergency responders can better understand the unique needs of dialysis patients during a disaster.

To take this step, dialysis facilities should first initiate contact with their local emergency teams, schedule meetings to educate them about the facility's operations and the urgency of dialysis care, and establish mutual aid agreements or memorandums of understanding (MOUs) to ensure these teams are ready to support the facility in times of crisis. This collaborative approach is the backbone of effective emergency preparedness.

STEP 2: Create a Hazard Vulnerability Plan and a Communications Plan

Once you have emergency services on board, begin developing your Hazard Vulnerability Assessment. This will guide your facility in identifying the most relevant risks and how to mitigate them. Afterward, create a comprehensive communication plan that involves not only your emergency partners but also your facility's staff, patients, and their families. It’s essential that everyone is on the same page and knows how to communicate effectively during and after an emergency.

A communication plan should outline how staff will stay connected, how patients and their families will be informed, and ensure that all necessary contacts are readily accessible. This will also ensure that, in the event of an emergency, staff know how to communicate with each other and with patients to make sure everyone is safe and accounted for.

STEP 3: Establishing the Continuity of Operations: External Partners, Staff, and Backup Facility

Continuity of operations involves two key components: ensuring you have backups for both your supplies and your staff. Emergencies can disrupt supply chains, so it’s essential to have systems in place to maintain the supplies you need to keep your facility running.

We always focus on external partnerships, but the staffing situation is equally crucial. Emergencies affect staff members too—they’re people with families, homes, and responsibilities. They might need to evacuate, or be unable to come into work because they're helping loved ones. During these times, how will your facility remain operational? You must have strategies to support staff during an emergency. 

One example of a facility supporting their staff during a natural disaster comes from Puerto Rico during Hurricane Maria, where dialysis centers provided childcare for their staff.

Another creative solution Yessi has seen implemented is moving essential staff closer to facilities during times of crisis.

Simple measures like this can make a huge difference in ensuring your facility has the staff it needs during a crisis. Aside from plans for external partners and staff, facilities should select a backup facility in case they are forced to close. 

STEP 4: Patient Education and Preparedness

It's vital that dialysis patients understand their role in the facility’s emergency preparedness plan. They need to know what to do when the plan is activated, how to stay safe, and how to maintain their treatment during a disaster. Patients should be trained in basic actions, such as disconnecting from their machines if necessary, and be well-versed in their individual dietary and fluid restrictions.

Instead of just verbally explaining emergency protocols, facilities should engage patients in hands-on training so they can practice these actions. This kind of training builds confidence, preparing them for the possibility that staff may not be immediately available to assist them during a crisis.

Personal preparedness for patients also involves knowing their diet and fluid restrictions, having emergency contacts ready, and ensuring the facility also has those contacts. All of these elements are essential to both the facility's emergency plan and the patient's individual preparedness plan

STEP 5: Creating a Post-Disaster Recovery and Review Plan

Emergency plans should be living documents, constantly evolving and improving as new situations arise. Part of the emergency preparedness plan should include a post-disaster recovery and review phase. After each emergency, the facility should evaluate what worked and what didn’t, and then update the plan accordingly. This ongoing process of review and revision ensures that the facility is better prepared for future emergencies.

Are there any other key skills or strategies you think that staff should be trained on to handle crises effectively?

In crisis situations, heightened emotions are a natural reaction for patients and their families, who may feel anxious and unsettled by sudden disruptions. For healthcare staff, managing these moments calmly is key, which is why training in de-escalation techniques and stress handling is so valuable. Equally important is encouraging staff to practice self-care, supporting their own well-being so they can continue to provide effective care. Facility social workers can greatly assist by coordinating these training opportunities, equipping teams to face challenging events with resilience and empathy.

Dialysis facilities face significant challenges in managing resources like supplies, medications, and equipment during a disaster. How do the ESRD Networks support these facilities in effectively managing their resources to ensure continuity of care in such situations?

While the ESRD Networks do not directly provide supplies to facilities, they play a role in offering guidance. In the past, the Networks have received calls from facilities facing supply shortages during emergencies. Although they may not have the resources to respond directly, they act as vital connectors, linking facilities with organizations that can provide the necessary support.

Before disasters strike, the recommendation is always for facilities to establish strong relationships with local healthcare coalitions, as these coalitions often include organizations with access to essential supplies. Conducting resource audits on supply needs regularly also help facilities keep an accurate birds eye view of their needs. In this way, facilities can be better prepared to manage supply needs proactively, ensuring they have access to critical resources when emergencies arise, as well as not put additional pressure on an already strained system.

What are some key steps that dialysis patients can do for themselves to personally prepare?

Key steps dialysis patients can take to prepare for a disaster include creating an emergency kit with essential supplies, medications, and medical information. Patients should also communicate with their dialysis center to understand backup facilities and contact numbers in case their usual facility is closed. Having a transportation plan and staying informed about local resources is crucial. Additionally, patients should utilize the ESRD Networks as a resource if they cannot reach their facility, ensuring continuity of care during emergencies.

What are some dietary tips for dialysis and chronic kidney disease patients to help them maintain their health during a disaster, especially when access to fresh food may be limited?

During an emergency, patients need to stick to their dietary plans, even when access to fresh food is limited. Controlling fluid intake, and monitoring potassium, sodium, and phosphorus levels is crucial. It’s important for patients to work closely with their dietitians to develop personalized plans that will help them stay healthy during emergencies when resources may be scarce. Local resources and organizations, such as the West Virginia Chronic Kidney Disease Prevention Program, can connect patients with registered dietitians, who are covered by insurance for CKD and diabetes care, to help create these plans.

More Information on Disaster Preparedness for Dialysis Facilities and the Full Podcast Episode

For those seeking more information on this topic, visiting your local ESRD network's website is a great starting point. With 18 Networks across the United States, you'll find valuable resources to support your needs. The National Coordinating Centers (NCC) also provides a helpful map with contact details for each ESRD Network, including QIRN 3, QIRN 4, and QIRN 5, which you can find here at Quality Insights. Additionally, KCER's website serves as a national resource for emergency management in the dialysis community. To hear the full dialogue from this interview session, be sure to listen to Taking Healthcare by Storm: Industry Insights with Yessi Cubillo.

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