THE DOCUMENTS which follow
ARE ATTACHMENTS TO THE
KIDNEY COMMUNITY EMERGENCY
RESPONSE COALITION REPORT
OF jULY 1, 2006
EMERGENCY PREPAREDNESS
for Dialysis Facilities
A Guide for Chronic Dialysis Facilities
“When WHAT IF becomes WHAT NOW?”
As stated in this manual, “An emergency stops being one when you are prepared for it”.
As a demonstration of that fact, we have included a few historical accounts of what some dialysis facilities experienced in different kinds of disasters. It is the hope of the Facility Operations Committee of the National Disaster Coalition that these stories will provide you with information on the importance of disaster planning as well as motivate you to take action.
A Hurricane Katrina Experience
From News You Can Use, the Network 13 News Letter, Issue 21 October 2005.
A PERSPECTIVE: “Katrina: The Flooding of Baton Rouge”
Marie R. Duncan, LCSW-BACS
As Hurricane Katrina flooded the New Orleans area with her waters, she flooded the Baton Rouge area as well. Not with water but with dialysis patients. Fresenius Medical Care, NorthAmerican (FMCNA), the largest provider of dialysis in the Baton Rouge area, was now faced with an unprecedented challenge.
In preparing for Katrina, the administration made the decision to dialyze our Monday patients on Sunday, August 28th, with some units being asked to dialyze both Monday and Tuesday patients on that Sunday. This was done in anticipation of Katrina’s hit on Monday, August 29th. As predicted, she was the hurricane that the New Orleans area always feared!
As FMC employees returned to work on Tuesday, August 30th, we waited for the patients we knew would come. And they did. Walk ins were arriving at all 16 facilities in the Baton Rouge area, prisoners on dialysis were expected at DCI, every hospital was calling with dialysis patients in their emergency room (ER), shelters were calling our Admission coordinator with 20 to 30 patients at a time, and nursing homes were calling with new admits. Complicating our mission was the news that some of our facilities had sustained damage from Katrina, leaving them immediately inoperable. The Technical Department worked diligently to get those units up and running while efforts were being made to dialyze Baton Rouge and New Orleans patients at other units. Some units were operating without the luxury of air conditioners, computers, phones, or fax machines; making communication very difficult. Unit secretaries had to go to other units to complete daily tasks while trying to obtain necessary information from patients to later enter in the computer. For some, this remained a problem days after Katrina’s hit. By day’s end we had dialyzed an additional 229 patients from Katrina. An incredible task, but it was far from over.
Wednesday, September 1st, brought the realization that our job was just beginning. The Admission coordinator’s beeper went off all through the night Tuesday alerting her to new calls left on her voice mail. This continued the entire week after Katrina. The influx of patients was phenomenal and the logistics of treating them a tremendous challenge. We were going to need more shifts, more staff, more supplies, better transportation, and more medications such as EPO.
The Technical Department, while overseeing repairs to damaged facilities, also had to obtain more supplies such as dialyzers and lines (supplies that were hard to get because of Katrina). Unit secretaries trying to order more medications were faced with the same problem as well. Clinic managers were trying to create more shifts at their perspective units to meet the demand but staffing was a huge issue. Nurses and patient care technicians worked extremely long hours to care for the patients entrusted to them. Some staff waited for hours after treatment with a patient because transportation back and forth to the shelters was less than perfect. To address this problem our Regional Vice President contracted with transportation companies to transport patients and FMC paid for services provided.
More staff was desperately needed and volunteers did come from other states. Though very welcomed and very much needed, they too were a focus of concern. The Regional Vice President and our two Area managers had to work out lodging, transportation, meals, and scheduling issues. Lodging was no small task considering Baton Rouge hotels were booked due to the previous evacuation of New Orleans. Out of town staff slept on air mattresses in the Area managers’ offices until RVs were obtained and set up. The In-service Department assisted the managers with multiple tasks including working out the logistics of licensed personnel working in another state while the Technical Department acted as a taxicab service back and forth to the airport.
Patients continued to arrive in the Baton Rouge area, some now too sick to dialyze in a unit. Our physicians admitted these patients and the Acute Dialysis Staff cared for them during their hospitalization. Physicians, nurse practitioners, and social workers also went to the Pete Maravich Assembly Center (PMAC) Special Needs Shelter to identify dialysis patients and assess their immediate needs.
As mentioned earlier, you may recall that some units had dialyzed all of their patients on Sunday, August 28th, leaving those units available for Katrina patients only. This however posed another problem. These Katrina- evacuated patients now needed somewhere else to dialyze because Baton Rouge patients would be returning to their regular shifts. A team was formed of two social workers, the Admission coordinator and her assistant. Their goal was to schedule all Katrina patients currently in Baton Rouge and new arrivals by creating a master list. Coordinating 16 units and the constant arrival of new patients was a daunting task. The number of patients was important to every department because this determined what efforts had to be made to meet their needs. Social workers, dietitians, unit secretaries, ward clerks, and nurses provided daily updates leading to the development of this ongoing list. During that first week, the list was constantly changing. Some patients used Baton Rouge as a “pit stop” on their way elsewhere. Understandably, many left without notifying the unit. However, a patient not returning was valuable information because that was a chair that could be used for new patients arriving daily. “Who did you admit today?’ “Who did not come back?” “How many chairs do you have left?”; “Have you opened up another shift?” were the questions asked over and over again. All the while the Admission coordinators phone rang and rang and rang.
During the week of the hurricane this team worked endless hours updating the list so that when the phone rang “tomorrow”; and we knew it would, the patient could be placed as soon as possible. How many additional patients did we dialyze since Katrina? The answer: 577. Because of our close working relationship with the other dialysis providers in Baton Rouge, we also know that Renal Care Group (RCG) dialyzed an additional 106 patients and Earl K. Long dialyzed 40. This is a total of 723 patients!
The writer of this article would be remiss if the human side of our story went unmentioned. The New Orleans patients not only needed dialysis, they needed compassion. Many arrived with only the clothes on their back, lacking sleep, and food. Dietitians provided nutritional supplements, went shopping, and made sandwiches for patients. A doctor’s wife and his daughters made hundreds of sandwiches as well, distributing them to units. Many employees brought clothes to their units to donate to Katrina’s victims. Social workers assisted with resource information. Patients wanted to tell “their story” so we listened; nurses, patient care technicians, dietitians, and social workers.
FMC employees worked extremely long and hard hours, all the while dealing with their own personal issues caused by Katrina. Many employees had multiple family members in their own home, no electricity, property damage from Katrina, and child care issues because schools were closed. Just getting to work on time was a challenge because Baton Rouge literally doubled in size, causing severe traffic problems.
Did we do everything perfectly? No. Were we successful? If success is measured by “No patient being turned away”, then YES WE WERE.
To date, FMC Baton Rouge continues to have an additional 216 patients brought to us by Hurricane Katrina, all now receiving dialysis at their new “home unit”. Many say that they will not return to New Orleans, having nothing for which to return.
The aftermath of Katrina continues. Some of the New Orleans FMC facilities are now beginning to reopen. The Baton Rouge and New Orleans Area managers are coordinating efforts to assist displaced FMC employees with housing, transportation, and food so that they can return to work at their units. New Orleans physicians and all providers of dialysis in the New Orleans area are attempting to locate their patients and we are assisting them with this information.
Katrina presented the Baton Rouge area with an unwelcome challenge, one that we accepted. Then there was Rita…
An Arson/ Bomb Scare Experience
Nora Dalaudado RN, Clinical Manager, Satellite Dialysis - Watsonville, California
Twice in less than a week, the Satellite Dialysis facility in Watsonville became a victim of arson as a result of an incendiary device being thrown at the facility. The first incident occurred at 11 o’clock the night of Wednesday, January 25, 2006. The facility was closed and an incendiary device was thrown against the exterior wall and only caused minor damage to the building, but resulted in major media attention and generated fear among the staff and patients. Repairs were done before the week was over.
The second attempt, on Monday January 30, again occurred when the unit was closed around 9 PM. Someone broke a window in the treatment areas and threw the incendiary device in. The fire damaged about a fourth of the treatment area. Luckily water damaged was limited to the immediate area because the sprinkler system was designed to activate as needed only and not the whole building.
The facility was forced to close even though only one fourth of the facility appeared visibly damaged. There were the issues of environmental effects of burnt equipment, smoke and possible water damage to the floors. Since the police department felt the two incidences were related, there was also serious concerns over whether this could have been caused by a disgruntle ex-employee or someone with a grudge and they would perhaps return.
This emotional trauma to the employees, patients and their relatives was one of the biggest concerns, but problems had just begun. Here’s what we learned:
What worked?
The Employee Assistance program resource was contacted the day after the second arson. Two separate meetings on 2 successive days were scheduled. Attendance was almost 100%.
Emergency affiliation with a dialysis facility, Satellite in Santa Cruz (15 miles away) proved to be a tremendous advantage. Patient’s treatments were scheduled in the affiliate facility the following day and for the duration of the closure of the clinic.
Emergency Dialysis Orders were readily available. Although the existing emergency orders were meant for natural disasters, they served as a blueprint for the Medical Director and Clinical Manager.
Employees reviewed the “disaster diet” with the patients. This action was deemed necessary in the event that a similar crime or power outage occurred in the affiliate clinic, crippling the only functioning dialysis facility in the county.
The transportation agencies in Santa Cruz County were more than willing to transport the patients the 15 miles from the Watsonville facility for as long as it took to repair the damage and get the facility to full functioning capacity. It was gratifying to feel their heartfelt willingness to help the patients get to their treatments.
The Regional Director and Corporate Technical Manager came to survey the damage as soon as they were notified. The decision was made to close the unit and the Medical Director was notified. The Regional Director notified the COO, the State Health Department and the Network. As a result of the phone call the Department of Health representative came and surveyed the damage.
The Watsonville Fire and Police Departments deserve recognition for their rapid response to the 911 calls. Even days after the arson, a member of the departments readily responded to phone calls.
The Corporate Tech manager informed the Facilities Administrator who arranged for contractors to survey the damage and plan repairs. The City of Watsonville building inspector was also notified and visited the facility.
The Equipment technician made arrangements for equipment and supplies to be transported to the affiliate unit in Santa Cruz to help support the extra patient load.
Friends of Satellite, volunteered to help transport the machines and chairs that were needed for the next day treatments at the new facility.
The facility's unit secretary came in to assist in making phone calls to patients and staff to inform them where to go the next day and to tell what had happened.
The nephrologists admitted patients to both facilities, so continuality of care continued.
Not to be forgotten is the security agency that monitored the facility. It was their initial phone calls that activated all the responses and were there to provide added support afterwards, since we were all fearful of further incidences.
What we learned:
There are good people in this world.
The dialysis facility needs to partner with outside agencies to develop a simple but rapid response to major emergencies that arise.
Designate a media contact (both units should have one) - expect the media to call. They will appear at your doorstep; they will stalk and hound. It is part of their job.
Have ready a short but script for the media designate to follow. This prevents misquotes and erroneous information. Remember to be courteous to the media. There was a cordial relationship between the clinical manager and the media during this period and they respected the limits that were imposed.
Keep open communication lines with the city authorities. They became friends.
Foster good working relationships with area emergency rooms and acute dialysis services.
Look beyond your immediate neighborhood for other places that you could send patients in case there is not enough room in the immediate area.
Develop a staffing plan that allows your staff to be available to do the clinic affiliates and assist the “home staff”.
Don’t forget to make "thank you” phone calls and send cards.
Above all take care of yourself. Stay in touch with the Employee Assistance program counselor and heed their advice.
The Watsonville facility was finally inspected and cleared by the City and the State and reopened its doors on Friday, March 10. Security cameras are in place. The goal is to make sure that all staff and patients continue to feel safe once again. There was a final meeting with an EAP counselor a week after the unit reopened. It was an appropriate beginning.
An Earthquake Experience
Submitted by Danilo Concepcion based on an interview with John Lodge.
On January 17, 1994, the people around Northridge, California, were awakened at 4:31 a.m. by a magnitude 6.7 earthquake. The fault responsible for the earthquake ran underneath the San Fernando Valley and had been unknown before the Northridge Earthquake.
The quake was felt for 2,000 square miles in Los Angeles, Orange and Ventura counties. There were nearly 15,000 aftershocks following the main earthquake. The earthquake killed 57 people and injured nearly 12,000 people. The damage was extensive, damaging about 100,000 houses and businesses. Parking garages collapsed and some apartment buildings were reduced to rubble. The earthquake caused more than $40 billion in damage, 25, 000 buildings uninhabitable, 9 hospitals closed (2500 beds), 2 bridges on the I-10 Santa Monica Freeway collapsed, 3 bridges on Route 118 Simi Valley Freeway collapsed, 2 bridges on I-5 Freeway collapsed, 2 bridges (Gavin Canyon Bridges) on I-5 collapsed, 22, 000 people were left homeless and 7, 000 buildings red-tagged.
According to the Technical Manager of an FMC unit, it was fortunate that the quake occurred during the hours that the building was still unoccupied. The air conditioning system for the building fell through the ceiling. PVC pipes for the distribution loop snapped. Large pre-treatment tanks fell. The unit was categorized uninhabitable and red-tagged.