2008 CMS/ESRD Networks Annual Meeting Baltimore, MD February 21, 2008

1. Disaster Preparedness and Responsein the ESRD Community: the role of ESRD NetworkLana Kacherova & Sarah Yelton 2008 CMS/ESRD Networks Annual Meeting Baltimore, MD February 21, 2008

3. Emergency Preparedness & Response: 2 components • Internal (all Network staff works together as a team to develop processes in place to be operational during an emergency or disaster) • External (ability to serve the Network provider & patient community during disaster and communicate facilities’ open/closed status)

4. ESRD Network Statement of Work (SOW). Task 2.e. • Assist providers/facilities in developing plans for local emergencies/disasters as specified under Task 2.d; • Maintain a phone system to ensure that Network staff members can be contacted as necessitated by the emergency/disaster;

5. ESRD (SOW). Task 2.e.(cont). • When an emergency or disaster affects any portion of the Network’s area, track availability of services and assist patients in identifying; dialysis facilities that can provide ESRD services. • The Network shall track and make available to the public the open and closed status of the facilities in the affected area. This information may be posted on the Network’s Web site or a link may be provided to a central Web site, as available;

6. ESRD (SOW). Task 2.e.(cont). • Assist family members and treating facilities in locating displaced patients and exchanging critical medical information for those patients. In the event of an emergency or disaster, CMS will provide direction related to HIPAA regulations. • Organize and participate in national and/or regional calls with providers, emergency workers, and other essential persons to ensure coordination and that the needs of individuals with ESRD are being met

7. ESRD (SOW). Task 2.e.(cont). • As directed by CMS, assist other Networks in carrying out contract requirements during the initial phase of an emergency and/or disaster and during the recovery phase; • Establish a partner relationship with another Network to provide back-up assistance in the event of an emergency/disaster

8. Types of Disasters • Earthquake • Fire and Ice • Flooding • Hurricane • Tsunami • Terrorism • New threat – pandemic flu

9. Northridge Earthquake ~ 1994

10. Northridge Earthquake ~ 1994

11. Northridge Earthquake ~ 1994

12. California Firestorm ~ 2007

13. California Firestorm ~ 2007

14. California Firestorm ~ 2007

15. California Firestorm ~ 2007

16. Midwest Snow and Ice

17. Midwest Ice Storm 2007

18. Tornado: Greensburg, Kansas 6/07

19. Tornado: Kansas 2007

20. Missouri River Flood

21. Hailstorms

22. Oil Refinery spill and floodCoffeyville, Kansas 7/07

23. Chemical Plant Fire Kansas City, Mo 2/8/07

24. Flooding in Kansas 2007

25. Lessons Learned from California Earthquakes, and from Katrina, Wilma & Rita • Dialysis facilities and dialysis patients are not included in any regional, state, or federal disaster efforts • Although we consider dialysis patients as a “special needs population”, who is to say that their needs are any more important than any other frail or vulnerable group

26. More Official Quotes • “For the first 72 hours after a major quake, don’t count on outside help of any kind” • “The bigger a potential disaster, the more the local community should plan for its own response”

28. Internal Network Preparedness: Preparation for an emergency: • Develop an internal Network Plan for preparedness & response, including arrangements with back-up Network if local office operations are impaired • Develop staff call tree and test it periodically • Have major provider group and Network emergency contact numbers available at each employee work station • Develop clear staff role assignments

29. Example of Staff Role Assignments: Executive Director • Notify CMS PO, CMS Region, back-up Network, and maintain daily communication with them • Conduct daily de-briefing with the Network staff • Back up: (QID and PSD)

30. Example of Staff Role Assignments: Administrative Department • Maintain list of contacts and calls • Daily fax blasts to facilities • Send DPAR on the 5th day of disaster with detailed instructions • Back up: Data (IM) Department

31. Example of Staff Role Assignments: Quality Improvement Department • Notify LDO Regional Contacts and State Survey Agency Contacts and maintain open communication with them • Back-up: Patient Services Department

32. Example of Staff Role Assignments: Patient Services Department • Notify the Office of Emergency Services (OES) and KCER and maintain open communication with them • Back-up: QI Department

33. Example of Staff Role Assignments: Outreach Coordinator • Update dialysisunits.org website and the Network website about facilities open/closed status at least daily or more often if necessary and possible • Back-up: other staff members trained on the website maintenance

34. External ESRD Network Preparedness: Working with Provider Community

35. ESRD Regulations of 1976. Section 405.2140 (d) Emergency Procedures - Standard • Established written plan for dealing with fire and other emergencies • All personnel are trained in all aspects of emergencies for any emergency or disaster • Availability of a fully equipped emergency tray and staff are trained on its use • Training of staff and patients on handling medical and non-medical emergencies

36. Section 405.2160 Affiliation Agreement or Arrangement • (a) between outpatient and hospital-based dialysis units • (b) Provides the basis for effective working relationships

37. Section 405.2139 (b) Protection of Medical Record Information • “The ESRD facility safeguards medical record information against loss, destruction, and unauthorized use”.

38. 4 Keyes To Being Prepared for a Disaster (KCER) • Determine what kind of disaster you may expect • Evaluate the readiness of your dialysis facility • Prepare your staff • Prepare your patients

39. Facility Readiness • Secure the facility • Keep patient and business records secure • Have a back-up utility plan • Refer to CMS Manual “Emergency Preparedness for Dialysis Facilities” (CMS-11025)

40. Prepare Your Staff • Identify the disaster Organizational Structure • Develop a communication plan and test it regularly • Educate key personal in their role during disaster • Have a back-up facility agreement • Know in advance who to contact for assistance and information: - ESRD Network - City, County and State Emergency Response Teams - American Red Cross Chapter - Security Company

41. Prepare Your Patients • Handing out a copy of a facility’s disaster plan • Disaster drills (do not discontinue dialysis treatment during a drill) • Emergency disconnect (Clamp and Cut or Clam and Disconnect) • Distributing medical emblems identifying patients as dialysis patients • Distributing a copy of the CMS booklet: “Preparing for Emergencies: A Guide for People on Dialysis”.

42. Prepare Your Patients (cont) • Gather and carry important medical information • Awareness about alternative arrangements for treatment • Preparing an emergency stock of supplies, food, and medication • Know “survival diet” to follow if dialysis treatment must be delayed

43. Know Your Resources • Take the time to develop a personal relationship with the key people at your utility services: electrical, water and gas • Let them know that you patients well being depends on the electricity or water • Ask them to put you on a priority list on case of shortages • Find out if they have a backup plan that may help you – Get yourself included!!

44. Know Your Resources (cont). • Meet with your Local Office of Emergency Management (OES) • Provide information on the needs of dialysis patients • Ask for them to include your facility and patients in their disaster plan • Find out who will set up and run emergency shelters, and have some designated as the GO-TO places for dialysis patients (This may or may not be the American Red Cross)

45. Patient Provider Tracking • Facility Open & Closed Web site on nephron.com • Emergency Data Set • LDO’S to produce for all patients bi-annually (pre-hurricane season in coastal areas) • NRAA to inform independents and hospitals • Disaster Patient Activity Report • Through ESRD Networks • Begins DAY 5 post emergency • Continues twice a week

46. Possible Resources • Centers for Medicare & Medicaid Services (CMS) • ESRD Networks • Federal & State Emergency Response Agencies • Office of Emergency Services - www.oes.ca.gov • KCER Website: www.kidney.org/help or www.kcercoalition.com • KCER Coalition Hotline: 1-800-901-3773 • The rule of thumb-for the first 72 hours after a major disaster, don’t expect outside help of any kind!

48. Possible Resources (cont.) PrepareNow.org • A volunteerism project, Ready to Respond, to mobilize and deploy volunteers for disaster response • These websites link to many other important and helpful agency websites

49. Possible Resources (cont.)

50. The Bottom Line • In the end, it all comes down to taking responsibility for our own safety • Think about the unthinkable • Preparedness is the most effective way to eliminate panic • An emergency stops being one when you prepare for it