Disasters and Dialysis  Northwest Renal Network                 and      Northwest Dialysis        Emergency   Preparednes...
Dialysis Facts-More than 386,000 people are currently diagnosedw/ end stage renal disease + require dialysis or  /        ...
What is Dialysis?A medical treatment that cleans wastes    from the blood artificially when        the kidneys are unable....
Complications of no DialysisHigh Potassium levelsThe kidney can no longer filter out higher levels  of Potassium which can...
Excess Fluid- can cause pulmonary edema and death.
Pericarditis-Pericarditis    Inflammation of the sac around the heart. As a result of being under-dialyzed
Dialysis FacilitiesDialysis facilities are very dependent on    y                      y   pelectricity and water for thei...
Dialysis StaffThe nurses and technicians that perform thedialysis treatment have had specializedtraining.training They are...
The Patient’s Connection to     the Dialysis Unit  Patients receive life sustaining                   life-sustaining   tr...
Patients have a close connection to thestaff and other patientsFeel that the unit is a home away from home
Hemodialysis:      The use of a machine toclean wastes from the blood, using an artificialfilter.
How?- Large bore needles are placed in a special access iin th patient’s arm      i l           the  ti t’- Blood is pumpe...
Peritoneal Dialysis:Cleaning the blood by using the lining  of the abdominal cavity as a filter
How?Through a catheter placed in the abdomen,fluid is introduced. The fluid draws waste andexcess fluid from the tiny bloo...
Both of theses types of dialysis can and are done in private homes everyday    The issues for home treatment are:         ...
Dialysis unit emergency plans        must indicate: Who- is responsible for what duties Where- evacuation routes and      ...
The N   Th Nurse Manager (RN)            MThe fi tTh first point of contact, f ll           i t f     t t followed b      ...
Fact-Most patients often do not have theirown transportation + rely heavily on      city/county transportation         y/ ...
Fact -Multiple types of disasters can easily impact the routine of the dialysis              patient
What Quantities are Needed? Electricity-Electricity is the primary source of power for dialysisclinics for:           runn...
How much electricity are   we t lki      talking about?               b t? An average family pays approx.          g      ...
What Quantity ?Water  For each gallon of water that is purified,             g                     p       ,   typically ½...
Requirements for Dialysis TreatmentsSpace to do the treatmentElectrical Power to run the equipment        If electricity i...
Requirements for Dialysis Treatments cont.Dialysis machines - There are a wide variety of                    makes and mod...
Typical watertreatmentequipment in afacility includes:Carbon filtration +either-    reverse osmosis          or     deioni...
Requirements for Dialysis Treatments (cont.)          Supplies            Dialyzers, blood lines, saline,               me...
Requirements for Dialysis Treatments       (cont.)     A doctor’s prescription for dialysis +     medical records to suppo...
Dialysis Community Emergency           Preparedness Assessment (3/17/2010)                    Findings:   from 164 of 167B...
Findings    (cont.)Dialysis supplies on site    Only 83% of facilities reported the number of    days of on-hand supplies ...
Findings   (cont.)Backup water supply   Only 16% of facilities reported having access to a   backup water supply and the p...
Findings   (cont.)Emergency supplies    On average only 41% keep emergency    food, water, blankets and medication supplie...
Findings   (cont.)Alternate communication system    28% have an alternate communication        system if phones are out   ...
Northwest Dialysis Emergency         Preparedness Coalition            p                 RecommendationsAll facilities sho...
RecommendationsDialysisDi l i supplies-           li   Minimum 14 day supply is recommended
Recommendations (cont.)Emergency Food + Water -           Enough for all patients+ staff               for 3 shifts x 3 days
RecommendationsCommunications –    Alternatives to cell phones- i.e.. Pay phones,     out of state cell, satellite, or ham...
RecommendationsEmergency drills thatactively includepatients, not just staff.Currently at mostfacilities they talkthrough ...
Currently, patients are taught-      Clamp and Cut- procedure to                    quickly get taken off                 ...
Relationships in the Community     The local emergency managers are           essential to our efforts!Questions to consid...
QuestionsDoes your jurisdiction include dialysis and kidney transplant patients as    part of the vulnerable pop ?        ...
QuestionsDo you kno how many ESRD    o know ho manpatients and providers are in yourjurisdiction?
Through December 31, 2010     there were 11 326 dialysis                11,patients in the five state Network 16
ResourcesNorthwest Renal Network  www.nwrenalnetwork.orgKidney Comm nit EmergencKidne Community Emergency Response(KCER) w...
www.nwrenalnetwork.org•Website section specificallyfor Emergency Preparednesscovers information for      • Patients      •...
Maps available for all 5 states
Blow-ups of Portland and Seattle
Resources (cont.) To check the open/closed status of any dialysis unit in the USA following a large     y                 ...
Simple Changes to ConsiderEncourage early evacuation of individuals with kidney failure if they are on dialysis           ...
Since services are needed on a frequent                                  qbasis, the individual should be:        Triaged ...
Issues in Disasters    Many dialysis facilities may be      inoperable    Patients can be scattered in the      evacuati...
Simple Changes (cont)               p       g ( )Add questions to the shelter admission forms     qasking:         Do you ...
Dialysis is a Necessity- Not an option    This is a basic life support that becomes morevital to a dialysis patient than a...
Patient concerns if treatment  iinterrupted by a disaster:     t     t db     di tHeightened sense of fear and confusionMa...
Make shelter personnel aware that dialysis di l i patients h             ti t have some very     strict dietary restrictio...
The Emergency DietPatients are given and taught about theemergency diet     g     yThe diet reduces the components that wo...
What Shelters Need to Understand     Shelters do not need to provide dialysis      treatments      t   t    t     Dialysis...
Questions?   Please feel free to contact:       S a o adge . .       Sharon Badger R.N. Community Education CoordinatorNor...
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Disasters and Dialysis

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 Sharon Badger, Community Education Coordinator, Northwest Renal Network
This presentation will provide an overview of the end stage of renal disease and the treatments that must
be maintained by the patient until there is a kidney transplant or the patient dies. The presentation will
encourage the disaster planning community to incorporate the special requirements of the kidney
community into local and regional emergency and disaster plans. It will encourage the emergency
managers to utilize both the Network and the individual facilities to create a plan that can best serve this
vulnerable population

Published in: Health & Medicine, Travel

Disasters and Dialysis

  1. 1. Disasters and Dialysis Northwest Renal Network and Northwest Dialysis Emergency Preparedness Coalition Serving: Alaska  Idaho  Montana  Oregon  Washington
  2. 2. Dialysis Facts-More than 386,000 people are currently diagnosedw/ end stage renal disease + require dialysis or / g q ytransplant to sustain their lives.Dialysis treatments are 3 times per week week.Each treatment lasts 3-4 hours
  3. 3. What is Dialysis?A medical treatment that cleans wastes from the blood artificially when the kidneys are unable. There are two kinds
  4. 4. Complications of no DialysisHigh Potassium levelsThe kidney can no longer filter out higher levels of Potassium which can interfere with the electrical conduction of the heart.
  5. 5. Excess Fluid- can cause pulmonary edema and death.
  6. 6. Pericarditis-Pericarditis Inflammation of the sac around the heart. As a result of being under-dialyzed
  7. 7. Dialysis FacilitiesDialysis facilities are very dependent on y y pelectricity and water for their operations. They Th cannot operate without t t ith t the required utilities.
  8. 8. Dialysis StaffThe nurses and technicians that perform thedialysis treatment have had specializedtraining.training They are licensed and/or certified certified.
  9. 9. The Patient’s Connection to the Dialysis Unit Patients receive life sustaining life-sustaining treatment There are approx.15 hrs/week spent at the unit
  10. 10. Patients have a close connection to thestaff and other patientsFeel that the unit is a home away from home
  11. 11. Hemodialysis: The use of a machine toclean wastes from the blood, using an artificialfilter.
  12. 12. How?- Large bore needles are placed in a special access iin th patient’s arm i l the ti t’- Blood is pumped out of their body, p p y cleaned and pumped back in
  13. 13. Peritoneal Dialysis:Cleaning the blood by using the lining of the abdominal cavity as a filter
  14. 14. How?Through a catheter placed in the abdomen,fluid is introduced. The fluid draws waste andexcess fluid from the tiny blood vessels. Then vesselsthe fluid is emptied. This gets repeated.That iTh t is called an exchange. ll d h
  15. 15. Both of theses types of dialysis can and are done in private homes everyday The issues for home treatment are: Training Support and Supplies
  16. 16. Dialysis unit emergency plans must indicate: Who- is responsible for what duties Where- evacuation routes and meeting places gp When- Order of emergency procedures How – Proper emergency disconnection and other procedures
  17. 17. The N Th Nurse Manager (RN) MThe fi tTh first point of contact, f ll i t f t t followed b d by the charge nurse on duty.
  18. 18. Fact-Most patients often do not have theirown transportation + rely heavily on city/county transportation y/ y p
  19. 19. Fact -Multiple types of disasters can easily impact the routine of the dialysis patient
  20. 20. What Quantities are Needed? Electricity-Electricity is the primary source of power for dialysisclinics for: running water treatment equipment equipment, dialysis machines, computers, etc.
  21. 21. How much electricity are we t lki talking about? b t? An average family pays approx. g y p y pp $1-200.00/month for their service A dialysis clinic serving 50 patients pays approx. * $7-1800.00/month *This is a discounted rate.
  22. 22. What Quantity ?Water For each gallon of water that is purified, g p , typically ½ to 1 gallon goes down the drain. Example: If a clinic has 50 patients, with treatments 3 times per week- 13,000 gal. of water/wk on the high end 9,750 gal. on the low end.
  23. 23. Requirements for Dialysis TreatmentsSpace to do the treatmentElectrical Power to run the equipment If electricity is not available, one machine would require a 1 65KW size generator 1.65KW An average facility has 16-20 machines + a water treatment system which will require at least a 50KW generator
  24. 24. Requirements for Dialysis Treatments cont.Dialysis machines - There are a wide variety of makes and modelsPotable water for use in the treatment se Each treatment requires a minimum of ~ 100 gallons of treated, pressurized water
  25. 25. Typical watertreatmentequipment in afacility includes:Carbon filtration +either- reverse osmosis or deionization
  26. 26. Requirements for Dialysis Treatments (cont.) Supplies Dialyzers, blood lines, saline, medications, etc medications etc. Personnel qualified to perform dialysis
  27. 27. Requirements for Dialysis Treatments (cont.) A doctor’s prescription for dialysis + medical records to support the treatment Ah hospital or other similarly equipped system it l th i il l i d t + means to transport if complications occur while providing dialysis
  28. 28. Dialysis Community Emergency Preparedness Assessment (3/17/2010) Findings: from 164 of 167Backup generators Only 37% of responding facilities reported backup generators on-site. An additional 9% of facilities had a transfer switch installed.
  29. 29. Findings (cont.)Dialysis supplies on site Only 83% of facilities reported the number of days of on-hand supplies they stored on site. 22% reported 1-2 weeks of supplies % f i 48% reported 2-3 weeks of supplies
  30. 30. Findings (cont.)Backup water supply Only 16% of facilities reported having access to a backup water supply and the proper plumbing hook-up hook up to accept water water.
  31. 31. Findings (cont.)Emergency supplies On average only 41% keep emergency food, water, blankets and medication supplies pp
  32. 32. Findings (cont.)Alternate communication system 28% have an alternate communication system if phones are out 30% have cell phones as backup
  33. 33. Northwest Dialysis Emergency Preparedness Coalition p RecommendationsAll facilities should have: Generators – Or at minimum a transfer switch in all new construction
  34. 34. RecommendationsDialysisDi l i supplies- li Minimum 14 day supply is recommended
  35. 35. Recommendations (cont.)Emergency Food + Water - Enough for all patients+ staff for 3 shifts x 3 days
  36. 36. RecommendationsCommunications – Alternatives to cell phones- i.e.. Pay phones, out of state cell, satellite, or ham radios
  37. 37. RecommendationsEmergency drills thatactively includepatients, not just staff.Currently at mostfacilities they talkthrough the situation.
  38. 38. Currently, patients are taught- Clamp and Cut- procedure to quickly get taken off the dialysis machine machine. (leaves about 1 cup of blood behind) Designated meeting place Duck and cover head with blanket (for earthquake)
  39. 39. Relationships in the Community The local emergency managers are essential to our efforts!Questions to consider: Are you aware of the special requirements of daily care? q y
  40. 40. QuestionsDoes your jurisdiction include dialysis and kidney transplant patients as part of the vulnerable pop ? pop.?
  41. 41. QuestionsDo you kno how many ESRD o know ho manpatients and providers are in yourjurisdiction?
  42. 42. Through December 31, 2010 there were 11 326 dialysis 11,patients in the five state Network 16
  43. 43. ResourcesNorthwest Renal Network www.nwrenalnetwork.orgKidney Comm nit EmergencKidne Community Emergency Response(KCER) www.kcercoalitiion.com
  44. 44. www.nwrenalnetwork.org•Website section specificallyfor Emergency Preparednesscovers information for • Patients • Dialysis Facilities • Emerg. Managers
  45. 45. Maps available for all 5 states
  46. 46. Blow-ups of Portland and Seattle
  47. 47. Resources (cont.) To check the open/closed status of any dialysis unit in the USA following a large y g g disaster, go to- www.dialysisunits.com www dialysisunits comLook up may be done by city, State, facility name, or zip code.
  48. 48. Simple Changes to ConsiderEncourage early evacuation of individuals with kidney failure if they are on dialysis With appropriate family members (where possible)
  49. 49. Since services are needed on a frequent qbasis, the individual should be: Triaged g Provided with urgent care Evacuated to a location where services can be provided repeatedly in a safe environment The location environment. may be a great distance away.
  50. 50. Issues in Disasters Many dialysis facilities may be inoperable Patients can be scattered in the evacuation Utilities and supplies can be scarce Local communications can be disrupted
  51. 51. Simple Changes (cont) p g ( )Add questions to the shelter admission forms qasking: Do you require dialysis? Have you had an organ transplant?
  52. 52. Dialysis is a Necessity- Not an option This is a basic life support that becomes morevital to a dialysis patient than anything else during an emergency.Patients will become critically ill and perish without treatment. treatment
  53. 53. Patient concerns if treatment iinterrupted by a disaster: t t db di tHeightened sense of fear and confusionMay be physically weak, dizzy, disorientedMay have just begun treatment at time ofdisaster and be anxious about next treatment.
  54. 54. Make shelter personnel aware that dialysis di l i patients h ti t have some very strict dietary restrictions- Low sodium Low potassium Low protein Reduced Fluids R d d Fl id
  55. 55. The Emergency DietPatients are given and taught about theemergency diet g yThe diet reduces the components that wouldcause problemsThere is a version of the diet for diabetic andnon-diabetic patients. di b ti ti t
  56. 56. What Shelters Need to Understand Shelters do not need to provide dialysis treatments t t t Dialysis p y patients need a clean space to p use for treatments Dialysis facilities need a supply of clean potable water
  57. 57. Questions? Please feel free to contact: S a o adge . . Sharon Badger R.N. Community Education CoordinatorNorthwest Renal Network (Network 16) 206-923-0714, ext 206 923 0714 ext. 102 sbadger@nw16.esrd.net www.nwrenalnetwork.org

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