Dialysis Patient Needs In A Disaster

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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 patients arm. Blood is pumped out of their
  body, cleaned, and then pumped back in.

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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.

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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

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Facility Disaster Preparation

• Secure the dialysis facility
• Secure equipment to minimize potential harm to
  persons or property
• Secure medical records
• Secure business records

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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.

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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

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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

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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

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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

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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

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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.

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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.

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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

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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

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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

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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

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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

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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

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Thank You! Questions?
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Links

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

Special Thanks to ESRD Network 16 for Developing
This Resource! www.nwrenalnetwork.org Linda Ball,
QI Director Jim Curtis, QI Consultant (Feel free
to modify this presentation as needed)
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