1. PREPARING FOR DISASTER THE IN-PATIENT DIALYSIS UNIT Barbara Richter, RN, BSN, MA Clinical Nurse Manager Mount Sinai Medical Center Renal Treatment Center

2. BEFORE A DISASTER STRIKES: • Outpatient Staff are prepared • They know their collaborating units and contact numbers. • They know their disaster plan and how to implement it. • They have a disaster plan for their family members and know how to reach them. • They know the patient disaster hotline number.

3. BEFORE A DISASTER HITS: • Patients are prepared: • They have a “TO GO “ bag with: • a 3 day supply of medications • their dialysis prescription • current medication list • 1 – 2 doses of kayexelate with sorbitol • bottled water • some canned food • one change of clothing • They have been in-serviced • They know what will happen if they are in the dialysis unit • They know where to call, if at home. (Hotline)

4. ASSUMPTIONS: • The hospital is functioning. • The Command Center is up and running. • There is communication with the satellite units that are down.

5. REALITY: • The hospital is full and needs to discharge patients using established criteria. • The dialysis unit is functioning at full capacity: • A handful of chronic adult outpatients • Chronic pediatric outpatients • Chronic in-patients • Acute in-patients • ICU patients (10-16 off center treatments/day)

6. The Plan: • The Renal Treatment Center: • 12 stations will be adapted by Y-connectors to accommodate 2 dialysis machines each • 2 additional stations will be created using the R/O hook-up from the technical/equipment room • Dialysate flows will be reduced to 500cc/minute, if necessary • Patient treatments may be reduced to 2 hours • Dialysis unit will run 24 hours • 4 bedded area converted to dialysis unit, using 4 off-center R/O’s and dialysis machines

7. The Plan: • Staff: • Nurse and technical staff that are present will be mandated to stay • Plans are made to stay open 24 hours • Nurse and technical staff at home will be told not to report to work until 1st shift goes home • Medical Director will assure physician coverage 24 hours • Staff from other institutions: • Need to bring some disposable supplies • May need to bring machines • May work with our dialysis staff to take care of their patients (the logistics of this still needs to be worked out)

8. REALITY (Cont’d): • Patients are told to go to the nearest ER. • The ER is dealing with a large influx of “injuries”. • The Renal MDs will need to assess every patient that needs dialysis.

9. REALITY (Cont’d): • The command center is not focusing on dialysis: • The Emergency Room is busy with injuries • The Emergency Triage Area is sorting levels of injury • The Operation Rooms are busy with emergency surgery

10. THE PLAN: • The renal department needs to handle the dialysis patients: • Set up triage for ESRD patients in or near the dialysis unit • Injuries go to Emergency Room • ESRD patients are placed on schedule

11. THE PLAN: • The Clinical Nurse Manager, the Charge Nurse, the Medical Director, the Administrator and the Technical Manager will meet, confer and activate the plan. • Set up a triage room in the unit. • Decide which patients’ treatments can be cut. • Arrange to open the area designated to put 4 portable dialysis machines and chairs/stretchers.

12. THE PLAN: • The staff is notified of the initial plan and updated often. • The administrator arranges for the paper work and clerical staff is set up to get all demographic information, from patients not associated with the hospital. • Home Dialysis Unit • Name • Date of Birth • Social Security Number • Insurance Information • Weights and Heights • Actual Billing Will Come Later

13. THE PLAN: • Treatment prescriptions will be individualized but basically will be: • 2 hours treatment • The dialysate flow may be decreased • Regularly prescribed blood flows • No routine IV meds, i.e. Epogen, Aranesp, Zemplar, etc • In-patients will be dialyzed in their room

14. REPONSIBILITIES: • At the satellite: • The Nurse Manager or Charge Nurse will notify: • Medical Director of Dialysis • Administrator • Nurse Manager or Charge Nurse at the hospital • Medical Director or his/her designee will notify: • Chief Operating Office • Chief Medical Office • Vice President for facilities

15. RESPONSIBILITIES: (Cont’d) • The administrator will make arrangement : • To transport: • Dialysis machines • Disposable supplies • Work with Social Worker & Nutritionist to contact transportation companies to aid in patient transport • Contact the network • Call patients at home to give their new pickup schedule

16. RESPONSIBILITIES: (Cont’d) • Nurse Manager at the hospital unit • Staff all areas appropriately • Staff for 24 hours operation • Along with the Medical Director and Administrator, stay in touch with the hospital command center and satellite units.

17. POST DISASTER: • All players need to meet to discuss: • What went well • Problem Areas • Changes to be made