Texas renal disease providers are on the forefront of emergency planning for special needs patients and their new, innovative system passed its first real-life test.
The survival of thousands of Texan End-Stage Renal Disease patients depends on lengthy dialysis treatments every two or three days at dialysis facilities. Those facilities require power, fresh water, waste-water disposal, sanitary environments and access for patients and staff — all of which were cut off during Hurricane Ike.
In the wake of Hurricanes Katrina and Rita, the state’s dialysis community formed the Texas ESRD Emergency Coalition, or TEEC, to maintain continuity of care during disasters. Although Hurricane Gustav was almost a mock drill in impact, Ike was the real thing: by wiping out facilities in Galveston and the coast and shutting down Houston services, the storm and its aftermath had the potential to shut down dialysis patients’ kidneys — and lives.
“It’s not the hurricane that will kill them, it’s the days after without electicity, water, medication, appropriate food and dialysis,” says TEEC chairman Harvey Sanders, RN, ROD, regional operations director for Davita, Inc., in Dallas.
Since special needs shelters don’t provide dialysis and may lack transport to services, TEEC volunteers stepped in to relocate coastal and other evacuees to areas near facilities with adequate service capacity, or available “seats.” In Houston, the post-hurricane problems that impacted residents hit dialysis centers even harder.
“Almost 100% of Houston dialysis centers were affected by loss of power, broken windows or flooding,” says Sanders. Reopening isn’t easy. Although bleach is effective for minor water damage, centers affected by greater flooding require complete professional cleaning, including walls. Since the water wasn’t contaminated in storm-affected areas, Houston facilities could use reverse osmosis to purify water they used for treatment, providing they could transport staff and their own supplies of power, water and protection.
“No security is provided by the state, county or local government, so dialysis companies had to hire guards to protect their generators, fuel, water and transport,” says Saunders. “Traffic was a horrible issue because it blocked staff and patients. Some patients didn’t go to their usual providers because it was easier to reach others that were closer to home.”
Dialysis facilities can’t simply add extra beds or work around the clock, they require specialized equipment and specialized staff. While treatment length can sometimes be shortened during emergencies (down to about two hours from three or more) and facilities can run 20 hours a day, they require four hours to shut down for servicing.
“The state doesn’t dictate, direct or assist [facilities that] opens first or last, whether hospitals or independent canters,” says Sanders. “TEEC fully understands that independent units don’t have the resources of major providers, so we assist them.”
That assistance and collaboration started well before the storm touched land.
Three days before Ike hit, the TEEC steering committee decided via conference call to activate their statewide ESRD Command Center in Dallas and asked local members to staff it. Due to prior planning and negotiations, they were able to base their operations at Dallas county’s Emergency Medical Services command center to coordinate services.
“The county command center allocated phone and computer lines, so we had only so many places at the table, but our volunteers almost always exceeded the numbers allowed,” says Sanders. “All dialysis providers had someone at the command center every day, and every organization sent updated lists of available seats.” And collaboration wasn’t because they were competing for clients, marketshare or brownie points, he says. “All providers truly wanted to help and facilitate patient care.”
A major component of the TEEC plan was to implement and publicize a toll-free number for patients and providers during disasters. “We did a very good job promoting it,” says Sanders in something of an understatement.
The TEEC disaster line was deluged with calls from patients, hospitals and emergency organizations, peaking at 4,000 to 5,000 per day before the storm and continued coming in three days after the storm.
Round the clock, eight or nine volunteers worked to coordinate and direct their care. They identified the patients in each area who needed evacuation, matched them with facilities that had the most available seats, then reported the information to the state health command center in Austin to coordinate evacuation.
One goal was to relocate patients and staff to the same areas. That way, displaced staff who were willing to work could augment existing staffing, while providing familiarity and continuity for care for disaster-stressed patients in unfamiliar surroundings. The result exceeded expectations.
“We had patients and staff teammates living together in shelters,” says CJ Fleniken, RN, CNN, Davita, Inc. group administrator for facilities in Galveston, the coast and Houston. “We’ve never been through anything like this before.”
A Failure to Communicate
The command center and call line worked well, but problems arose elsewhere. Along with power, the storm knocked out cell phones, land-line phones and computer servers.
Volunteers at the command center also facilitated the transfer of medical information from patients’ regular dialysis center to their disaster provider.
As a precautionary measure, providers extended their hours and called in unscheduled patients for shorter treatments to shore up their health status prior to physical and emotional stress, and to “tide them over” temporarily if dialysis treatments were delayed.