Observations from the emergency management of dialysis patients evacuated from the US Virgin Islands to Puerto Rico following hurricane Irma

Abstract

Two category 5 hurricanes, Irma and Maria, arrived in the Caribbean in September 2017 in rapid succession. On September 6, Irma devastated the islands of St. Thomas and St. John, in the Virgin Islands of the United States (USVI). Most medical infrastructure was damaged, including hemodialysis facilities, paralyzing dialysis operations. After Irma’s landfall, Puerto Rico served as a safehaven for thousands of displaced and repatriated persons from the impacted islands. These included a cohort of 129 hemodialysis patients evacuated from St. Thomas, USVI to San Juan, Puerto Rico from September 9−11, 2017. The hemodialysis patients arrived first at hotels in San Juan and were then transferred to a Special Needs Shelter, run by the Commonwealth of Puerto Rico and located in the Puerto Rico Convention Center. With the imminent arrival of Hurricane Maria, most patients were evacuated on September 19 to a special needs shelter on the campus of the Florida International University, in Miami, Florida. While in San Juan, hemodialysis treatments were provided by local nephrologists working with local hemodialysis centers. Here, we describe the challenges and the emergency management actions taken to ensure continuity of care, including providing dialysis, general medical care, shelter, food and transportation for USVI dialysis patients during their stay in San Juan, Puerto Rico. We describe here the experiences of federal and host state/territorial officials in the special needs shelter, in the context of the state/territorial and federal response to disasters, in order to provide ideas about challenges, solutions, and approaches to coordinating care for dialysis patients evacuated from a disaster.

Inclement Weather and Risk of Missing Scheduled Hemodialysis Appointments among Patients with Kidney Failure

“…This challenge has been well documented in regions struck by Hurricanes Katrina, Sandy, and Maria and Winter Storm Uri. 7,8,[29][30][31] After Hurricane Katrina in August 2005, 94 dialysis clinics closed for at least 1 week in the Gulf Coast states, including Louisiana, Mississippi, and Alabama. 29 A study investigated the factors associated with missed dialysis sessions after Hurricane Katrina and reported that the probability of missing three or more sessions was greater among those who lived alone before the hurricane's landfall, who did not evacuate before the storm, or who were placed in storm shelters.…”

“…8 In Puerto Rico, the landfall region of Hurricanes Irma and Maria in September 2017 experienced catastrophic damage to most medical infrastructure and paralyzed dialysis operations that resulted in mandatory patient evacuations. 30 Winter storm Uri in 2021 caused mass power outages throughout Texas and affected approximately 54,000 dialysis patients. 31 The Intergovernmental Panel on Climate Change report suggests imminent and increased extreme weather magnitudes, duration, and frequencies with substantial alterations in regional patterns of extreme weather.…”

“…8 In Puerto Rico, the landfall region of Hurricanes Irma and Maria in September 2017 experienced catastrophic damage to most medical infrastructure and paralyzed dialysis operations that resulted in mandatory patient evacuations. 30 Winter storm Uri in 2021 caused mass power outages throughout Texas and affected approximately 54,000 dialysis patients. 31…”