Dialysis Patient Needs In A Disaster

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What is Dialysis?

• Dialysis is a medical treatment for people who have kidney failure.

• Dialysis patients come into a dialysis center three times a week to have the impurities cleaned out of the blood stream.

• Large needles are placed in a special access in the patient’s arm. Blood is pumped out of their body, cleaned, and then pumped back in.

Dialysis Facilities

• Dialysis facilities are very dependent on electricity and water for their operations. They cannot operate without the required utilities.

• The nurses and technicians that perform the dialysis treatment have had specialized training.

Facility Disaster Preparation

• Develop individual facility disaster plan• Build relationship with utility

representatives• Build relationship with local disaster

planners• Educate the staff and patients on disaster

plan

Facility Disaster Preparation

• Secure the dialysis facility• Secure equipment to minimize potential harm

to persons or property • Secure medical records• Secure business records

Emergency evacuation

• “Clamp and Cut” procedure to get off the dialysis machine quickly (leaves about 1 cup of blood behind)

• Designated gathering place• Emergency evacuation box should have

needed supplies for removing needles, etc.

The Patient Connection to the Dialysis Unit

• Patients receive life sustaining treatment • Spend a minimum of 15 hours a week at the

dialysis unit• Have a close connection to staff and other

patients• Feel the unit is a home away from home

Home Dialysis Patients

• Home hemodialysis patients have treatment at their homes 3 to 6 times per week

• Difficult to take a hemodialysis machine and supplies with them in an evacuation

• Will have the same needs as a hemodialysis clinic patient

Home Dialysis Patients

• Peritoneal dialysis patients perform treatment at home

• Can be done away from home• Some patients will be able to take supplies

with them and perform treatments away from home

• Greatest need will be a continuing source of supplies

Dialysis is a Necessity not an Option

• Patients will become critically ill and perish without treatment

• This is basic life support that becomes more important than anything else during a disaster

Patient Concerns if Treatment is Interrupted by a Disaster

• Heightened sense of fear and confusion• May be physically weak, dizzy, disoriented• May have just begun treatment at time of

disaster and will be concerned about next treatment

Issues in Disasters

• Many dialysis facilities may be inoperable • Patients can be scattered in the evacuation.• Utilities and supplies can be scarce • Local communication can be disrupted.

The Color Purple

Purple has been designated the official color of the Kidney Community in a disaster

We are encouraging the use of purple arm bands, wallet cards and signs for car windows to help identify kidney patients

Local Emergency Planners need to be aware of this, so that they recognize the significance of the color purple

Thanks to TEEC, the Texas ESRD Emergency Coalition for developing this concept.

Needs of Patients in a Regional Disaster

• Priority will be to find and receive treatment• Patients should have some disaster

preparation• As a group, they will be weaker and sicker

than the average person

Patient Disaster Preparation• Patients should be provided educational guides on

surviving a disaster, such as those created by CMS and the National Kidney Foundation

• The information in these manuals is general and will not work for every patient in every situation

• Information includes: Preparing for an emergency, gathering important medical info, alternative arrangements for treatment, emergency supplies, diet, disinfecting water

• Dialysis providers should provide additional patient education regarding their emergency plan

Patient Disaster Preparation

• Unless they are told to evacuate, patients are instructed to stay at home as long as it is safe to do so

• Patients should take emergency supplies with them, as listed in these manuals

• Start the emergency/disaster diet (sometimes called the three day diet) immediately

• If patients must go to a shelter, to inform the person in charge of their special needs

Dialysis Patient Special Needs During a Disaster

• INFORMATION! • Greatest fear will be where and when will

they receive treatment• Will want to know who is in charge• Will need to be reassured that their needs are

understood

Dialysis Patient Special Needs During a Disaster - Diet

• Special diet reduces protein and potassium• Sodium restriction is very important• Patient disaster manuals have detailed meal

plans included

Dialysis Patient Special Needs During a Disaster – Fluid

Restriction• Fluid Restriction will be a primary concern

in patient survival• Fluid overload is a major threat to health that

will lead to death if dialysis treatment is not received

• Fluid intake guidelines are included in the patient survival manuals

Thank You!Questions?

Links• www.ersdncc.org• www.kidney.org/help• www.kcercoalition.com

CMS Disclaimer: This presentation was developed by Northwest Renal Network while under contract with the Centers for Medicare and Medicaid Services, Baltimore, MD, contract # HHSM-500-2006-NW016C. The contents presented do not necessarily reflect CMS Policy

Special Thanks to ESRD Network 16for Developing This Resource!www.nwrenalnetwork.orgLinda Ball, QI DirectorJim Curtis, QI Consultant

(Feel free to modify this presentation as needed)