1) When a hurricane enters the Gulf of Mexico, the Texas ESRD Emergency Coalition (TEEC) command center is activated to advise callers on issues related to dialysis availability, transportation, emergency diets, and technical support. 2) TEEC professionals work with evacuees, emergency agencies, hospitals, shelters and EMS to coordinate dialysis services and communicate closures/availability through dialysisunits.com. 3) All dialysis patients are encouraged to register annually with the 211 transportation service in case evacuation is needed due to an approaching storm. 211 works to ensure dialysis patients without transportation can safely evacuate at least 3 days before a hurricane makes landfall.

1. Disaster Preparedness
Geli King Brown, MS

2. When a storm enters the Gulf of
Mexico….

3. When a hurricane enters the Gulf of
Mexico the Texas ESRD Emergency
Coalition command center is activated.
This is manned by ESRD professionals
who have knowledge of TEEC and the
dialysis community. They have to be
proficient in computer skills and have
the ability to work and remain calm in
high pressure. These people work in 12
hour shifts.

4. TEEC professionals advise callers on
dialysis availability, transportation
issues, emergency diets, triage,
technical issues to bring dialysis back on
line and reassurance. They work with
evacuees, the DSHS, State and local
agency emergency operations centers,
hospitals, shelters and EMS

5. Communication is handled through workers at
TEEC. TEEC integrates with EM and the network
with dialysisunits.com
If there is any computer or cell phone availability –
dialysisunits.com
We need to avoid people trying to go to a dialysis
unit through treacherous streets, downed trees and
powerlines, high water – only to get there and then
sit outside and wait, or be seen banging on the door
– even calling the police. This is poor
communication.
Some patients calling TEEC did not know the name
of their units or who their doctor was.
At least, if a unit closes put a sign on the door with
some valuable information.

6. Plan! Plan! Plan! Says the Director of Emergency
Management
Plan to be off guard. ESRD took everyone off guard. “Now
the State is ready”
Radio spots were not specific to ESRD patient – they told
everyone to stay hydrated.
The media needs to listen… and we have to constantly
remind them, continuously reinforce.
Emergency centers are not equipped to handle emergencies
and patients will sit there for hours. At least they check their
potassium levels.
Nursing homes make the decision to evacuate – and in the
event they do not – the patient may not have dialysis
availability. These services must be coordinated.
In an emergency a patient can be dialyzed without
paperwork. All that is needed is tuberculosis and hepatitis.
The reality in Houston is that many facilities were afraid to
dialyze patients without paperwork because they were
afraid they would be cited for being out of compliance.

8. TEEC contacts large dialysis
organizations 5 days out and
recommends evacuating 3 days out.
Given the nature of traffic in Houston,
for some it might be advisable to
evacuate even earlier for those in the
cone of uncertainty who have a place to
go, a relative who can assist with
dialysis.

11. The Texas 2-1-1 United Way Helpline
enables those residence who have no
means of transportation and need
assistance to evacuate.
At 72 hours out, those who are in the
database will be contacted by Harris
County and asked “There is a storm
coming. Do you need assistance?”
Yes or No. If not, they move on.
It is not just for the debilitated or
bedridden. Every dialysis patient
should register. One week a person
can drive, the next he/she cannot.
However, one MUST register each
year, and cannot do this at the last
minute. 211 must be 100% each
year.
The numbers of people registering
for 211 had been decreasing because
the general public has a short
memory of the devastation a storm
can bring.
There were several cases where
people contacted TEEC too late. At 6
PM a diabetic double amputee on
oxygen called and asked if some can
“come and get me.” It took the
Coastguard and an airlift operation.
This went on all night.
It is hard to believe – it seems as if
either no one talked to the patient,
or that it never sank in. It is the grim
reality.

13. 2-1-1- Transportation service
• Governor’s Division of Emergency Management “When hurricanes are on the way,
don’t stay.”
• Options are available for everyone who needs transportation out of a hurricane
zone.
• Individuals should call 2-1-1 to register for evacuation transportaion BEFORE THE
DISASTER PERIOD AND YEARLY
• There are trained specialists to take personal contact information and request
information about special needs.
• Each and every dialysis patient should register regardless of status because one
never knows what changes can happen.
• This 2-1-1 transportation registry is open year round, but is heavily promoted
during the hurricane season.
• Also, there is a 2-1-1 Texas/United Way help line that is available 24 hours/day 7
days/week. It offers phone assistance to those individuals who need to
understand what their options and available services are.
• The 2-1-1 system is activated during disaster events and local and stat emergency
management officials disseminate information about vital service availability.
Language interpreters are available to translate in more than 150 languages.

14. 2-1-1
• Road closures
• Evacuation routes
• Shelter locations
• TEEC – dialysis unit closures

16. UNDERSTANDING THE TERMINOLOGY
HURRICANE WATCH
This is within 36 hours and involves everyone in an area. All should listen. Evacuation may be
necessary
Monitor local media and check supplies, making certain there is ample fuel for the generators
and vehicles. Windows should be covered, and all all outdoor furniture, toys and tools brought
inside. Boats should be moored or moved to a safe place
HURRICANE WARNING
This is issued with winds greater than or equal to 74 miles per hour or dangerously high water
and rough seas are expected within 24 hours. All precautionary and preparatory actions
should be immediately completed.
All residents are urged to listen to radio and television for announcements and advisories.
Those living in low-lying areas or along the coast should move depending upon the zip code or
request from city officials. Those living in a mobile home should make sure their tiedowns are
secure and leave immediately. Those living on high ground should secure all openings, doors,
windows, garages of their building. Since water may not be available after the storm, it is
essential to store extra water in bathtubs and available containers. If requested, turn off
utilities. It is critical to stay away from windows, doors and openings.

17. DIALYSISUNITS.COM
When a dialysis unit is closed the LDO or the Network
administrator logs onto the dialysis.com server
(which is not located in the Houston-Galveston area)
and makes the change.
This is logged and can be tracked.
When the unit reopens, the database can be changed
again.
The list of dialysis units comes from CMS and is
updated every month.
Dialysisunits.com can be tracked from a mobile
device over the web using http://hh.nephron.com

21. EMSystems
• A patient tracking and evacuation system
• Able to integrate EMS, Hospitals and dialysis
facilities
• Central clearing house for critical information
• Support shelter status, volunteers, inventory
and resource management

24. R is for Rx (Prescriptions). Keep a list of all
medicines you take. Always have a week’s supply
on hand.
E is for E.R. Go to the emergency room if
you have serious problems. Here’s a list to
remind you.
A is for access to people & places. Make a
list of phone numbers most important to you.
D is for diet & liquids. Keep safe supplies
on hand. When you can’t go to dialysis, you
can’t drink much at all!
Y is for YOU! Make a plan with family,
friends & neighbors to stay safe.
R is for Rx (Prescriptions). Keep a list of all
medicines you take. Always have a week’s supply
on hand.
E is for E.R. Go to the emergency room if
you have serious problems. Here’s a list to
remind you.
A is for access to people & places. Make a
list of phone numbers most important to you.
D is for diet & liquids. Keep safe supplies
on hand. When you can’t go to dialysis, you
can’t drink much at all!
Y is for YOU! Make a plan with family,
friends & neighbors to stay safe.

25. E is for E.R., The Emergency Room.
Go to the Hospital E.R. if you have serious problems, like:
Major Injury. How are you hurt? ________________________
Pain that is not normal for you. __________________________
Unusual swelling. _____________________________________
Shortness of breath, trouble breathing. ____________________
Chest pain. _________________________________________
Blurry vision. _______________________
Others: ____________________________

28. Are You “R.E.A.D.Y.”?
Things to Remember
Put on your purple fanny pack
Put on your purple wrist band
Take your medications
Make sure the records from
your clinic are in the fanny
pack

31. Takeaways
• Educate and prepare patients for a disaster
– The Web has excellent resources
• TEEC is specific for ESRD
– Throughout the year is educating media and local officials
– During storm – mans a command center
• 211 Patients should register yearly for 211 assistance
• Responder dialysis
– One should dialyze patients in an emergency without a
2728. Most important is TB and hepatitis B status.
However, given the portability or information and with
proper preparation, patients should be able to provide
adequate information