Table 2 Elements of a plan to care for hemodialysis patients in disaster settings
Challenge | Approach | |
|---|---|---|
Intake evaluation | Prior history of illness, medications, surgeries, allergies, dialysis prescription will be needed | Some data will be available from the ESRD Network Develop intake form and make it readily available to the providers Copy form so that it is available immediately to providers and to administrative form |
Medications | Evacuees may leave quickly with few or no medications Almost all ESRD patients are covered by Medicare and some are covered by Medicaid, but co-pays cannot usually be paid by evacuees | Engage local pharmacies to determine if they have a mechanism for donating medications Patients should be encouraged to contact their health insurance providers to determine if a “refill too soon waiver has been implemented to allow replacement. Determine if the HHS Emergency Prescription Assistance Program (EPAP) can be activated |
Dialysis | Identifying facilities with capacity to absorb new patients | Help from ESRD Network |
Dialysis prescription | May not be immediately available from ESRD network Dry weight may be unknown Blood chemistries are likely to be unavailable | Generate a standard dialysis prescription |
Transportation to/from dialysis facilities | Three times per week May be four shifts | Contract for transport, including accessible buses and ambulances as a last resort |
Volunteers | Confirm professional staff qualifications Supervise volunteers | |
Emergency response | Personnel, equipment, transportation, road conditions | Paramedics and emergency medicine technicians 911 emergency response network |
Vascular access | Catheters and grafts, thrombose Grafts and fistulas may narrow | Identify vascular access clinic |
Dietary needs | Renal diet (low sodium, moderate potassium) Diabetic diet | |
Behavioral Health | Anxiety, depression, grief Anger over loss of family, friends, companion animals, and loss of control, Disorientation in new environment, possibly new state | Phone calls to family are supported, if cell service is available Spontaneous patient group discussions Counseling by psychology and social work |
Communication | orrC Coordinate dialysis schedules, response to acute medical and other needs | Teleconferences, Listserv |
Medical information and records | Coordinate and share data on medical history, medications, allergies, acute conditions, schedules | Electronic medical record Spreadsheets Access from laptop computers |