CJASN: Most dialysis patients are not prepared to effectively handle disasters

Most dialysis patients are not prepared to effectively handle man-made or natural disasters, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). This puts them in great danger of becoming seriously sick or dying in the face of a disaster.

Patients on dialysis depend on technology to keep them alive. But what happens when a disaster—such as the recent tornadoes in the Midwest or the earthquake in Japan—strikes? Disaster scenarios fall along two lines of response. During tornadoes or hurricanes, people must evacuate their homes and seek shelter in other locations. In these situations, dialysis patients should know where alternative dialysis clinics are, have medications on hand, and carry medical documentation of their kidney condition, among other precautions. Other events such as severe ice or snow storms require people to stay in their homes. In these situations, dialysis patients should be careful how much they drink, have a stockpile of appropriate foods and medications, and notify local police, fire, electric, water, and emergency services.

Mark Foster, Jane Brice, MD, Maria Ferris, MD, PhD (University of North Carolina School of Medicine) and their colleagues surveyed 311 patients who received care at various dialysis centers in central North Carolina.

Among the major findings:

•All dialysis centers had a disaster preparedness program in place, but most patients were not well-prepared for a disaster.
•Only 43% of patients knew of alternative dialysis centers.
•Only 42% had adequate medical records at home that they could take with them in short notice.
•Only 40% had discussed the possibility of staying with a friend or relative during a disaster.
•Only 15% had a medical bracelet or necklace they could wear if they were forced to leave their homes.
•Age, gender, race, education, literacy, and income did not affect disaster preparedness.

Results were slightly better when patients were asked about their preparations for disasters that would force them to stay in their homes. Fifty-seven percent knew what diet they should follow during a disaster, and 63% had a two-week supply of extra medications.

These findings are disturbing: disruptions in care for dialysis patients can seriously jeopardize their health. "A dialysis patient relies on frequent visits to a dialysis facility to maintain his or her health, and when patients cannot receive dialysis due to lack of clean water, lack of electricity, impassable roadways, etc., severe medical complications can occur quite quickly," said Foster. "This lack of preparation should stimulate measures to ensure better preparation for future disasters."

The results indicate that dialysis centers and medical organizations should work harder to educate and help dialysis patients prepare themselves for a potential disaster.