Disaster Preparedness Geli King Brown, MS
When a hurricane enters the Gulf of Mexico the Texas ESRD Emergency Coalition command center is activated. This is manned by ESRD professionals who have knowledge of TEEC and the dialysis community. They have to be proficient in computer skills and have the ability to work and remain calm in high pressure. These people work in 12 hour shifts.
TEEC professionals advise callers on dialysis availability, transportation issues, emergency diets, triage, technical issues to bring dialysis back on line and reassurance. They work with evacuees, the DSHS, State and local agency emergency operations centers, hospitals, shelters and EMS
Communication is handled through workers at TEEC. TEEC integrates with EM and the network with dialysisunits.com If there is any computer or cell phone availability – dialysisunits.com We need to avoid people trying to go to a dialysis unit through treacherous streets, downed trees and powerlines, high water – only to get there and then sit outside and wait, or be seen banging on the door – even calling the police. This is poor communication. Some patients calling TEEC did not know the name of their units or who their doctor was. At least, if a unit closes put a sign on the door with some valuable information.
Plan! Plan! Plan! Says the Director of Emergency Management Plan to be off guard. ESRD took everyone off guard. “Now the State is ready” Radio spots were not specific to ESRD patient – they told everyone to stay hydrated. The media needs to listen… and we have to constantly remind them, continuously reinforce. Emergency centers are not equipped to handle emergencies and patients will sit there for hours. At least they check their potassium levels. Nursing homes make the decision to evacuate – and in the event they do not – the patient may not have dialysis availability. These services must be coordinated. In an emergency a patient can be dialyzed without paperwork. All that is needed is tuberculosis and hepatitis. The reality in Houston is that many facilities were afraid to dialyze patients without paperwork because they were afraid they would be cited for being out of compliance.
TEEC contacts large dialysis organizations 5 days out and recommends evacuating 3 days out. Given the nature of traffic in Houston, for some it might be advisable to evacuate even earlier for those in the cone of uncertainty who have a place to go, a relative who can assist with dialysis.
The Texas 2-1-1 United Way Helpline enables those residence who have no means of transportation and need assistance to evacuate. At 72 hours out, those who are in the database will be contacted by Harris County and asked “There is a storm coming. Do you need assistance?” Yes or No. If not, they move on. It is not just for the debilitated or bedridden. Every dialysis patient should register. One week a person can drive, the next he/she cannot. However, one MUST register each year, and cannot do this at the last minute. 211 must be 100% each year. The numbers of people registering for 211 had been decreasing because the general public has a short memory of the devastation a storm can bring. There were several cases where people contacted TEEC too late. At 6 PM a diabetic double amputee on oxygen called and asked if some can “come and get me.” It took the Coastguard and an airlift operation. This went on all night. It is hard to believe – it seems as if either no one talked to the patient, or that it never sank in. It is the grim reality. www.hcoem.org
2-1-1- Transportation service • Governor’s Division of Emergency Management “When hurricanes are on the way, don’t stay.” • Options are available for everyone who needs transportation out of a hurricane zone. • Individuals should call 2-1-1 to register for evacuation transportaion BEFORE THE DISASTER PERIOD AND YEARLY • There are trained specialists to take personal contact information and request information about special needs. • Each and every dialysis patient should register regardless of status because one never knows what changes can happen. • This 2-1-1 transportation registry is open year round, but is heavily promoted during the hurricane season. • Also, there is a 2-1-1 Texas/United Way help line that is available 24 hours/day 7 days/week. It offers phone assistance to those individuals who need to understand what their options and available services are. • The 2-1-1 system is activated during disaster events and local and stat emergency management officials disseminate information about vital service availability. Language interpreters are available to translate in more than 150 languages. HURRICANE SEASPON JUNE 1 THROUGH NOVEMBER 30
2-1-1 • Road closures • Evacuation routes • Shelter locations • TEEC – dialysis unit closures
UNDERSTANDING THE TERMINOLOGYHURRICANE WATCH This is within 36 hours and involves everyone in an area. All should listen. Evacuation may be necessary Monitor local media and check supplies, making certain there is ample fuel for the generators and vehicles. Windows should be covered, and all all outdoor furniture, toys and tools brought inside. Boats should be moored or moved to a safe place HURRICANE WARNING This is issued with winds greater than or equal to 74 miles per hour or dangerously high water and rough seas are expected within 24 hours. All precautionary and preparatory actions should be immediately completed. All residents are urged to listen to radio and television for announcements and advisories. Those living in low-lying areas or along the coast should move depending upon the zip code or request from city officials. Those living in a mobile home should make sure their tiedowns are secure and leave immediately. Those living on high ground should secure all openings, doors, windows, garages of their building. Since water may not be available after the storm, it is essential to store extra water in bathtubs and available containers. If requested, turn off utilities. It is critical to stay away from windows, doors and openings.
DIALYSISUNITS.COMWhen a dialysis unit is closed the LDO or the Network administrator logs onto the dialysis.com server (which is not located in the Houston-Galveston area) and makes the change. This is logged and can be tracked. When the unit reopens, the database can be changed again. The list of dialysis units comes from CMS and is updated every month. Dialysisunits.com can be tracked from a mobile device over the web using http://hh.nephron.com
EMSystems • A patient tracking and evacuation system • Able to integrate EMS, Hospitals and dialysis facilities • Central clearing house for critical information • Support shelter status, volunteers, inventory and resource management
R is for Rx (Prescriptions). Keep a list of all medicines you take. Always have a week’s supply on hand. E is for E.R. Go to the emergency room if you have serious problems. Here’s a list to remind you. A is for access to people & places. Make a list of phone numbers most important to you. D is for diet & liquids. Keep safe supplies on hand. When you can’t go to dialysis, you can’t drink much at all! Y is for YOU! Make a plan with family, friends & neighbors to stay safe.
E is for E.R., The Emergency Room. Go to the Hospital E.R. if you have serious problems, like: Major Injury. How are you hurt? ________________________ Pain that is not normal for you. __________________________ Unusual swelling. _____________________________________ Shortness of breath, trouble breathing. ____________________ Chest pain. _________________________________________ Blurry vision. _______________________ Others: ____________________________
Are You “R.E.A.D.Y.”? Things to Remember Put on your purple fanny pack Put on your purple wrist band Take your medications Make sure the records from your clinic are in the fanny pack
Takeaways • Educate and prepare patients for a disaster • The Web has excellent resources • TEEC is specific for ESRD • Throughout the year is educating media and local officials • During storm – mans a command center • 211 Patients should register yearly for 211 assistance • Responder dialysis • One should dialyze patients in an emergency without a 2728. Most important is TB and hepatitis B status. However, given the portability or information and with proper preparation, patients should be able to provide adequate information