People with end-stage renal disease (ESRD) who receive dialysis in advance of widespread, disruptive disasters “are significantly less likely to need an emergency department visit or hospitalization in the week following the disaster and less likely to die within 30 days after the disaster,” according to a US Department of Health and Human Services (HHS) study published in the American Journal of Kidney Diseases.
HHS said the study “found that receiving early dialysis was associated with 20 percent lower odds of having an emergency department visit or 21 percent lower odds of a hospitalization in the week of the storm, and 28 percent lower odds of death 30 days after the storm.”
“Every disaster holds the potential to impact health and often disproportionately affect people who are medically vulnerable, including people who require dialysis,” explained Dr. Nicole Lurie, HHS assistant secretary for preparedness and response and one of the study’s authors. “This study provides the first evidence that receiving early dialysis in advance of potential disasters helps protect health and saves lives for dialysis patients and suggests that early dialysis should become a standard practice and protective measure.”
Dialysis patients’ lives depend on receiving multiple dialysis treatments each week. Disasters, particularly those with prolonged power outage and water restrictions, can cause facility closures and disrupt treatment schedules. Early dialysis in advance of a storm’s landfall helps protect patients while their facilities recover and reopen.
HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) conducted the study in collaboration with the Centers for Medicare & Medicaid Services (CMS) using Medicare fee-for-service data for 13,836 patients who received dialysis across the State of New Jersey and New York City, the areas most impacted by Hurricane Sandy. The data was provided in a way that protected personally identifiable information and individual patient privacy.
ASPR leads HHS’ efforts to prepare the nation to respond and recover from adverse health effects of emergencies, supporting communities’ ability to withstand adversity, strengthening health and response systems, and enhancing national health security.
Researchers sought to determine if early dialysis reduced the odds of a dialysis patient having an adverse outcome that included an emergency department visit or hospitalization in the week of the storm and death 30 days after the storm. Before Hurricane Sandy made landfall, 60 percent of ESRD patients received early treatment in 70 percent of the facilities in the impacted area.
“This study is part of a growing movement in the research community to provide scientific evidence to help patients, doctors, and community officials make decisions about how best to safeguard health from the impacts of disasters,” Lurie said. “The study also affirms the importance of dialysis facilities being fully prepared for disasters.”
The authors recommended that dialysis facilities conduct disaster drills to test emergency and communications plans and assess the staff’s ability to coordinate early dialysis in advance of an emergency. Drills also help determine their patients’ ability to understand, implement and arrive for treatment and identify potential gaps in facility and patient personal preparedness.
Veteran public health officials have repeatedly told Homeland Security Today though that the success of this — and other vital hospital environment life-saving measures — are dependent on how soon an area, or region’s, power can be restored, and how long a hospitals’ back-up generators will last.
They noted that during Hurricane Katrina and Sandy, some hospitals’ back-up power systems were inoperable because they were located in basements or at ground level where they were vulnerable to flooding.
HHS said, “Patients must understand how to request early dialysis and how to use emergency renal diet options to manage treatment delays. They also need to know how to seek care at pre-identified alternate dialysis facilities, which requires patients to be prepared to bring copies of their dialysis treatment plan and a list of their current medications when seeking treatment at an alternative facility or, as a last resort, in a hospital emergency department.”
The HHS study is part of a broader effort by the ASPR to help the nation become better prepared to address the needs of other at-risk populations, including children and medically vulnerable residents, during disasters.
Critics have also long complained, and numerous studies have revealed, that hospitals aren’t prepared for a large-scale surge of patients for a variety of reasons, like just in time supply systems. The critics also have said stockpiles of vital medications that people must take everyday or have on hand for various diseases will be in short supply during a large-scale catastrophic event.
And, they note, the Strategic National Stockpile may also not have enough everyday medicines on hand, not to mention the resources to get them delivered to where they’re needed.
For more on these issues, read the June/July 2014 Homeland Security Today cover report, When the Crossroads of Health Care and Public Health Never Meet, and, Forcing Emergency Preparedness on Health Care.