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Kidney Patient Care in Disasters: Emergency Planning for Patients and Dialysis Facilities

Jeffrey B. Kopp^*, Lynda K. Ball, Andrew Cohen, Robert J. Kenney, Kenneth D. Lempert^||, Paul E. Miller^¶, Paul Muntner^**, Nauman Qureshi, and Sarah A. Yelton

^* Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Northwest Renal Network (ESRD Network 16), Seattle, Washington; Department of Nephrology, Ochsner Clinic, New Orleans, Louisiana; Renal Associates of Baton Rouge, Baton Rouge, Louisiana; ^|| Nephrology Consultants of Northwest Ohio, Toledo, Ohio; ^¶ Miller Dialysis Acadiana Region, Ville Platte, Louisiana; ^** Department of Epidemiology, Tulane University, New Orleans, Louisiana; University of Alabama, Huntsville, AL; and Heartland Kidney Network (ESRD Network 12), Kansas City, Missouri

Address correspondence to: Dr. Jeffrey Kopp, Kidney Disease Section, NIDDK, 10 Center Drive, NIH, Bethesda, MD 20892-1268. Phone: 301-594-3403; Fax: 301-402-0014; E-mail: jbkopp{at}nih.gov

The catastrophic 2005 hurricane season alerted Americans to the need for a more effective response to mass casualty incidents. To address the needs of the nephrology community, the Kidney Community Emergency Response Coalition (KCERC) was formed, with representatives from more than 50 governmental agencies and private organizations. After completing phase 1 of its work, the KCERC issued recommendations for patients, dialysis units, and providers. During phase 2, the KCERC will promote implementation of those recommendations. During a disaster, the KCERC will host a daily conference call on which dialysis facilities, the End-Stage Renal Disease Networks, and emergency response officials will coordinate disaster response. Predisaster preparation for kidney patients should stress identification of alternative dialysis facilities, education about the renal emergency diet, and plans for early evacuation from the disaster area and for evacuating with medical documents and medications. Dialysis facilities are required to have a disaster plan; regular revision and rehearsal are essential. Critical issues for dialysis facilities include identification of partner facilities, a robust communications plan that takes into account the limitations of telephones and broadband access, staff shortages in the face of a possible influx of new patients, the delivery of service in the face of compromised utilities (water, power), and the recovery of a dialysis facility that experiences flooding or structural damage. A timeline to safety for dialysis patients can be visualized; if specific tasks are accomplished at each disaster stage, then it is likely that the health of these vulnerable patients can be protected.