Dialysis services in the hurricane-affected areas in 2005: lessons learned.

BACKGROUND: Hurricane Katrina resulted in partial or complete devastation of dialysis services throughout the Gulf Coast, including the New Orleans metropolitan area. In the immediate aftermath, dialysis had to be provided to patients by surrounding communities in Louisiana, and ultimately by dialysis programs throughout the nation. Peritoneal dialysis patients, though typically more independent, also endured challenges in continuing dialysis following Hurricane Katrina. Hurricane Rita caused similar damage to the western Gulf Coast at Lake Charles, Louisiana and Beaumont, Texas and further delayed recovery of dialysis services in the New Orleans metropolitan area. SETTING: A review of the problems created by the disaster provided many opportunities to improve healthcare delivery and to prepare for recovery from the event. Understanding what happened to the delivery of dialysis and chronic kidney disease services allows the opportunity to develop better systems to support this particularly vulnerable population of patients. CONCLUSION: Many lessons can be learned from these events to minimize future interruption of dialysis services in the face of natural disasters such as hurricanes.

Disaster planning for peritoneal dialysis programs.

Because of increased intensity of hurricanes in the Gulf Coast region of the United States, peritoneal dialysis (PD) programs have been disrupted and patients relocated temporarily following these catastrophic events. We describe the disaster planning, implementation, and follow-up that occurred in one such PD program in New Orleans following Hurricane Katrina. Each year at the beginning of the North American hurricane season, the PD program's disaster plan is reviewed by clinic staff and copies are distributed to patients. Patients are instructed to assemble a disaster kit and are provided with contact numbers for dialysis suppliers and for a PD program in their planned evacuation city. In July 2005, this disaster plan was tested when an early tropical storm and hurricane entered the Gulf and several patients briefly relocated or evacuated because of power loss and then returned without incident. However, when Hurricane Katrina, a category 5 storm, was predicted to strike the metropolitan area, patients were notified by telephone to evacuate, and contact information, including their evacuation city and telephone and cellular phone numbers, was obtained. Patients were also reminded to take all medications, bottled water, antibacterial soap, hand sanitizer, and 4-5 days of PD supplies. Following the storm, telephone and cellular phone services were severely disrupted. However, text messaging was available to contact patients to confirm safety and to provide further instructions. Arrangements with the major dialysis suppliers to ship emergency supplies to new locations were made by the PD nurse and the patients. Only 2 of 22 patients required hospitalization because of complications resulting from evacuation failure, contamination, and inability to perform dialysis for a prolonged period of time. Both of these patients were quickly released and have continued PD. Following the event, all patients remained on PD, and most have planned to return to their home PD program. Thorough preparation, planning, practice, and implementation and effective communication are necessary to prevent complications in PD patients who are affected by disasters. With advdnce preparation, maintenance of communication with health care providers, and planning for alternative sites of care, patients can be safely maintained on PD without complications following catastrophic natural disasters.