Disaster Preparedness and Awareness of Patients on Hemodialysis after Hurricane Sandy

Abstract

Background and objectives Patients with ESRD on dialysis live in a complex sociomedical situation and are dependent on technology and infrastructure, such as transportation, electricity, and water, to sustain their lives. Interruptions of this infrastructure by natural disasters can result in devastating outcomes.Design, setting, participants, & measurements Between November of 2013 and April of 2014, a cross-sectional survey was conducted of patients who received maintenance hemodialysis before and after the landfall of Hurricane Sandy on October 29, 2012 in lower Manhattan, New York. The primary outcome was the number of missed dialysis sessions after the storm. Dialysis-specific and general disaster preparedness were assessed using checklists prepared by the National Kidney Foundation and US Homeland Security, respectively. ResultsIn total, 598 patients were approached, and 357 (59.7%) patients completed the survey. Participants were 60.2% men and 30.0% black, with a median age of 60 years old; 94 (26.3%) participants missed dialysis (median of two sessions [quartile 1 to quartile 3 =1-3]), and 236 (66.1%) participants received dialysis at nonregular dialysis unit(s): 209 (58.5%) at affiliated dialysis unit(s) and 27 (7.6%) at emergency rooms. The percentages of participants who carried their insurance information and detailed medication list were 75.9% and 44.3%, respectively. Enhancement of the dialysis emergency packet after the hurricane was associated with a significantly higher cache of medical records at home at follow-up survey (P,0.001, Fisher's exact test). Multivariate Poisson regression analysis showed that dialysis-specific preparedness (incidence rate ratio, 0.91; 95% confidence interval, 0.87 to 0.98), other racial ethnicity (incidence rate ratio, 0.34; 95% confidence interval, 0.20 to 0.57), dialysis treatment in affiliated units (incidence rate ratio, 0.69; 95% confidence interval, 0.51 to 0.94), and older age (incidence rate ratio, 0.98; 95% confidence interval, 0.97 to 0.99) were associated with a significantly lower incidence rate ratio of missed dialysis.Conclusions There is still room to improve the preparedness for natural disasters of patients with ESRD. Provideror facility-oriented enhancement of awareness of the disease and preparedness should be a priority.

<p>Disaster Preparedness Impact In A Complex Ophthalmology Practice: A Review Of Patients Receiving Intravitreal Injections</p>

“…Other studies have also investigated the impact of natural disasters on patient care. [8][9][10][11][12][13] One study showed that timely deployment of emergency team and preparedness plan greatly assisted in the effectiveness of care delivery for patients. 8 Furthermore, the lack of preventable errors at hospitals can be attributable to strategic planning.…”

Earthquake Preparedness Among Japanese Hemodialysis Patients in Prefectures Heavily Damaged by the 2011 Great East Japan Earthquake

“…Our final instrument included five items: Do you know where there is another dialysis facility if the facility that provides your in‐center dialysis is damaged by an earthquake? Do you know how to control dietary intake when you may not be able to take dialysis during a week because of the collapse of all dialysis facilities in your local area? Do you have information networks to find out available dialysis facilities at the time when you face an earthquake?…”

“…Thorough preparation for natural disasters by national government, local government, dialysis centers, and patients can mitigate disaster influences . Previous studies have shown that disaster preparedness by hemodialysis patients is likely to mitigate missed dialysis sessions , and reduce comorbidity from depression and PTSD after disasters . However, our review showed that only a few previous studies have investigated the levels of disaster preparedness and the related factors that might affect this in hemodialysis patients .…”

“…Previous studies have shown that natural disasters have directly affected hemodialysis patients; for example, Anderson et al found that more than 44% of participants had missed at least one dialysis appointment, and nearly 17% had missed three or more, in the month after Hurricane Katrina hit the USA (2005). Murakami et al similarly reported that 26% of hemodialysis patients missed dialysis after Hurricane Sandy impacted the US (2012). Inui et al reported that the Kobe earthquake of 1995 had an impact on the provision of hemodialysis treatment for patients.…”

Renal Failure Patients in Disasters

“…17,18 A considerable literature has described the principles of disaster management for renal patients. 3,[18][19][20][21][22][23][24][25][26] Reports have included guidance for predisaster planning, strategies for the evaluation and treatment of patients, and management of dialysis-related issues. Other issues addressed include coordinating relief efforts, setting of priorities, resolving logistical issues, and recognizing pitfalls to be avoided.…”