Table 2.

Elements of a plan to care for hemodialysis patients in disaster settings

	Challenge	Approach
Intake evaluation	Prior history of illness, medications, surgeries, allergies, dialysis prescription will be needed	Some data will be available from the ESRD Network Develop intake form and make it readily available to the providers Copy form so that it is available immediately to providers and to administrative form
Medications	Evacuees may leave quickly with few or no medications Almost all ESRD patients are covered by Medicare and some are covered by Medicaid, but co-pays cannot usually be paid by evacuees	Engage local pharmacies to determine if they have a mechanism for donating medications Patients should be encouraged to contact their health insurance providers to determine if a “refill too soon waiver has been implemented to allow replacement. Determine if the HHS Emergency Prescription Assistance Program (EPAP) can be activated
Dialysis	Identifying facilities with capacity to absorb new patients	Help from ESRD Network
Dialysis prescription	May not be immediately available from ESRD network Dry weight may be unknown Blood chemistries are likely to be unavailable	Generate a standard dialysis prescription
Transportation to/from dialysis facilities	Three times per week May be four shifts	Contract for transport, including accessible buses and ambulances as a last resort
Volunteers	Confirm professional staff qualifications Supervise volunteers
Emergency response	Personnel, equipment, transportation, road conditions	Paramedics and emergency medicine technicians 911 emergency response network
Vascular access	Catheters and grafts, thrombose Grafts and fistulas may narrow	Identify vascular access clinic
Dietary needs	Renal diet (low sodium, moderate potassium) Diabetic diet
Behavioral Health	Anxiety, depression, grief Anger over loss of family, friends, companion animals, and loss of control, Disorientation in new environment, possibly new state	Phone calls to family are supported, if cell service is available Spontaneous patient group discussions Counseling by psychology and social work
Communication	orrC Coordinate dialysis schedules, response to acute medical and other needs	Teleconferences, Listserv
Medical information and records	Coordinate and share data on medical history, medications, allergies, acute conditions, schedules	Electronic medical record Spreadsheets Access from laptop computers