DISASTER PREPAREDNESS: Learning from KATRINA

NETWORK 13 ACTIVITIES COMMUNICATIONS NETWORK STAFFING TECHNICAL ASSISTANCE INFORMATION MANAGEMENT ACTIVITIES TO ASSIST DISPLACED PATIENTS

Internal Network Activities Pre-Hurricane Season Identify at-risk Louisiana dialysis facilities and patient population Review available dialysis providers/services within region (East TX, AR, West MS) Identify Emergency Operations Centers and Contact Info by Parish Review, Revise, and Distribute Network 13 Disaster Preparedness Planning Resource / Tools Louisiana Disaster Coalition (LA-DEEP)

Louisiana (‘At-Risk) 4,316 Patients receiving dialysis services as of 05/17/06 85 dialysis providers currently with ‘OPEN’ status 82 of these providers currently providing dialysis treatments 6 transplant providers

Hurricane Projected to Enter Gulf of Mexico Blast faxes to all NW 13 dialysis units to inform them of potential situation and to activate their disaster plans based on proximity (evacuating vs. receiving). Contact the nurse managers or regional administrators of units in potential strike area to inquire as to plans to dialyze, plans to evacuate.

WEB SITE: Hurricane Katrina The Greater New Orleans area and other areas are without power and many patients have evacuated or will be evacuated due to the catastrophic damage from Hurricane KATRINA! §         The dialysis community outside of these impacted areas can expect communications requesting transient dialysis services as they evacuate their communities. Be aware that cell phone towers in New Orleans area are down. Patients can call you on their cell phone, but you cannot call them back using their cell number. §         Also expect patients who may present without advance contact or medical records since the storm approached over the weekend. Patients with no records CAN STILL BE TREATED. All that is required is for a physician to write dialysis orders. Please be aware that it appears that this situation may be long-term and that the Network is doing everything we can to assist in the massive efforts to help the dialysis patients and providers in the affected areas. §         If the patients’ HbsAg status is unknown, provide treatment as potentially positive. If these patients are admitted for treatment before results of HBsAg or anti-HBs testing are known, these patients shall undergo treatment as if the HbsAg test results were positive, except that they shall not be treated in the HbsAg isolation room, area, or machine.   §         Network toll free numbers: [for patients 800.472.8664] or §         [EMERGENCY ONLY for facility staff 877.700.1196] §         We ask your patience and cooperation in assisting during this emergency. To assist Louisiana dialysis patients and facilities, we have the following emergency management resources available on our web site.  ESRD Network 13 Web Site  http://www.network13.org/katrina.htm  http://www.network13.org/patients.htm  http://www.network13.org/alert.htm  Suggested resources for download and printing An Emergency Preparedness Guide for Dialysis & Transplant Patients Preparación Para Emergéncias para Pacientes de Diálisis y Trasplante Emergencies Guide for People on Dialysis Prepárese para Emergencias: Una guía para personas en diálisis Uniform ESRD Transient Form  Medicare - Dialysis Facility Compare Website

ASSESSMENT / IMPACT Map locations of impacted dialysis facilities within region. Ascertain availability of dialysis services within Network region and then revise mapping of those locations of available dialysis facilities within Network for referrals and patient placements.

Communications… Telephones: Utilize cells, home, and previously established toll-free numbers Broadcast faxes: Facilitates communications throughout Network Web site (www.network13.org): Continuous updating throughout events Email: “Critical & Only” consistent way to communicate with operating hospital-based units in southern Louisiana during Katrina Daily Conference Calls: Establish to communicate and coordinate efforts throughout the region

NETWORK STAFFING 24 hour / 7 day Network coverage to be provided by the Executive Director and senior staff (QID, PSC, DM, ISD) during disasters impacting within three state service area. Patients: 1.800.472.8664 Dialysis/Transplant Providers: 1.877.700.1196

TECHNICAL ASSISTANCE Government Related Statements: A variety of information can be disseminated such as: Medicare, Medicaid Issues HIPAA Privacy and Disclosures in Emergency Situations CMS Survey and Certification Issues Health Care Personnel Licensure

Technical Assistance - Continued CDC / Infection Control Information: Water & Power Issues Safe Use of Tanker Water FDA advice when reopening HD clinics after restoration of power & water MMWR “Hurricane Katrina Response and Guidance for Health Care Providers, Relief Workers, and Shelter Operators” FDA Tips about Medical Devices and Hurricane Disasters Boiling Water Advisories

Technical Assistance - Continued Pharmaceutical / Dialysis Supply Resources Dialysis Unit Staffing Issues Donations (Funds & Resources) Transplant Information / Resources Mental Health Resources Additional Information Resources (ACGME guidelines for nephrology fellows, Red Cross FAQ’s, RenalWEB discussion boards)

DIALYSIS UNIT AND PATIENT TOOLS Several tools were developed secondary to Hurricane Katrina: Needs Assessment to help in development of dialysis unit disaster planning (LA-DEEP) Dialysis patient triage guidelines / checklist for shelter personnel Dialysis patient ID cards Dialysis staff and patient placards for use in automobiles for curfews/checkpoints Public service announcement template for utilization on local radio/TV outlets

Patient Needs Assessment

Baton Rouge Shelter

Kidney Disease Fact Sheet Area Shelters (shelter managers) Public Services (electricity, water) Public Safety (police, fire, sheriff) General Public (press, interested parties)

Triage Guidelines

Basic Triage Checklist

Patient ID Card

Disaster Poster for Waiting Areas

Dialysis Staff / Patient Placards

Sample Public Service Announcement (PSA) DIALYSIS PATIENT PUBLIC SERVICE ANNOUNCEMENT (Approximately 60 Seconds) September 20, 2005   Important Information for Dialysis Patients: If you are a dialysis patient, you need to continue to get dialysis at least three times a week. Call 1.877.886.4435 to get dialysis. Inform officials at shelters, during health assessments, and at check points that you need life saving dialysis often. Dialysis services are available! Call 1.877.886.4435 to locate a dialysis facility. Limit the amount of fluids you drink and the salt in your food if you use dialysis. Choose foods carefully and avoid fruits and vegetables high in potassium. Call 1.877.886.4435 for help getting dialysis.

INFORMATION MANAGEMENT Development and Maintenance of Dialysis Facility Status Listing Maintenance of Louisiana and Out-of-State Shelters Information MOST IMPORTANTLY!!! PATIENT TRACKING

ACTIVITIES TO ASSIST DISPLACED PATIENTS Networks, in partnership with the large dialysis organizations (DCI, DaVita, FMCNA) and independent dialysis providers, to continue to coordinate placement for transient dialysis patients.

CHALLENGES IN ASSISTING DISPLACED PATIENTS Multiple relocations as evacuation routes & shelters change Assistance in locating shelters close to available dialysis services Assist in locating missing dialysis patients for families and dialysis units Arranging or coordinating transportation as possible (major local issue)

Trailer/mobile city

THE FUTURE Preparing as best as possible for the uncertainties ahead There are still dialysis units in the greater New Orleans area which remain closed The Network recognizes that folks are still living and working in difficult situations. The Network remains available to assist within our role for the upcoming hurricane season.