Disaster Management in a Nephrology Service: Lessons Learned from Hurricane Maria

Abstract

Background: Puerto Rico suffered a major humanitarian ­crisis after Hurricane Maria. We describe our experience with patients with renal disease in an academic medical center. Summary: A comprehensive emergency response plan should be developed, shared and discussed with the team and the patients prior to the hurricane. The needs of the staff should not be ignored to ensure their ability to participate as responders. Physical damage to facilities, lack of basic services, shortage of disposable products, and the inability to get to treatment centers are the most common threats. Preemptive dialysis can avoid serious complications. A contingency plan to move patients to another center should be prearranged in case the unit is rendered nonfunctional after the storm. Patients must receive preventive education about fluid and dietary restrictions and the possible use of potassium binding drugs if they cannot reach a dialysis unit. A list of alternative drugs that could be used if patients are not able to fill their medications is required. The Internet and social media proved to be an invaluable communication tool. A registry of patients with updated contact information, as well as contact information for relatives and a physical address where an emergency rescue team can be dispatched is essential. Water safety should be reinforced. Key Message: Our experience showed us that preparing for the worst is not enough. Advanced planning of a streamlined response is the best tactic to decrease harm.

Role of the International and National Renal Organizations in Natural Disasters: Strategies for Renal Rescue

“…55 It is notable that 1 year after the hurricane 3 of the 52 dialysis units on Puerto Rico still are closed. 56 In the same article, Bonilla-Felix and Suarez-Rivera 56 reported their experience in Puerto Rico, adding a number of highly interesting recommendations for better preparedness for the future.…”

“…55 A more recent study reported by the Milken Institute of Public Health at The George Washington University estimated a total excess mortality of 2,975, similar to the death toll reported after the terrorist attack at the World Trade Center on September 11, 2001. 56 This makes Hurricane Maria the worst natural catastrophe in Puerto Rico in the past century and, after the 1900 Galveston hurricane, the second deadliest hurricane in US history, with a higher death toll than Hurricane Katrina.…”

Kidney problems in disaster situations

“…Deadly hurricane Maria devastated in 2017 most of Puerto Rico next to Dominica and the US Virgin Islands, making communication, transport and provision of water and fuel almost impossible for most of the affected area [75], impeding dialysis provision [75,76], and causing many patients to move elsewhere, especially to Florida [76].…”

Hospitals as disaster victims: Lessons not learned?

“…7 The emergency preparedness and response literature is growing and reflects an expanding interest in and evolution of the science of hospital preparedness. [8][9][10][11][12][13][14][15][16][17] Although there are general themes described in the literature from specific hospitals that have experienced disasters that disrupted normal operations and patient care, [18][19][20][21][22][23][24][25][26][27][28] and although there is literature describing how hospitals should prepare for and respond to internal and external disasters, to the best of our knowledge there are no structured reviews on this topic. The objective of this paper is to provide a structured, detailed review and description of the common themes and lessons from disaster events that directly affect hospitals and health systems via damage to physical infrastructure or degradation of resources, thereby disrupting the basic function of patient care.…”