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Practical Tips to Emergency Preparedness

John Dahlin CHT, CWS-1

Texas ESRD Emergency Coalition

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ObjectivesObjectives

1. Outline the basic technical information for disaster preparedness.

2. Review preparation & response activities.

3. Discuss lessons learned from previous disaster events.

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Staff - Personal Preparations

• Ensure that your staff have their own family disaster plans.

• Update phone & contact information.

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Physical Plant

• Contact landlords

• Exercise / test emergency equipment

• Boarding of exterior windows

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Physical Plant - continued

• Turn off water main

• Turn off city water booster pump

• Sandbag entryways

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Equipment

• Move equipment off floor

• Cover & tape all equipment with plastic

• Disconnect & move computer equipment to a centralized location.

• Disinfect dialysis machines prior to closing

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Water Treatment – Pre Storm

• Prepare the equipment for possible prolonged facility closure.

• Discuss with the equipment manufacturers regarding system outage lasting longer than 48 hours.

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Water & Concentrate Systems

• Reverse Osmosis Machines

• Distribution Systems

• Concentrate Prep

• Loops

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Inventory

• Place inventory items as high as possible onto pallets & shelving.

• Evaluate and ensure that the stockroom & supplies are usable and not damaged.

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Response• Following the storm and the surrounding

areas are deemed safe for re-entry.

• 1. SAFETY FIRST !!!

2. Inspect outside walls & roof of building

3. Do not enter building alone

4. Contact local law enforcement if building appears to be broken into.

5. If necessary, contact a contractor for evaluation of systems & structure.

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Assessments

• Verify utilities are operable

1. Electricity

2. Water

3. Sewer

• Notify Management of findings

• Take pictures of damage identified

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Re-opening Facility • Utilities

Coordinate any needs for generators, water tankers, equipment or supplies.

• Water Treatment

Turn on water main if previously closed.

Flush all pretreatment equipment to drain for 30 minutes.

Test chlorine levels before & after carbon tanks

Flush the distribution system to drain

Disinfect the RO and distribution system & rinse.

Replace all cartridge filters

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Re-opening Facility

• Water Treatment - continued

Perform full water testing procedures

Increase frequency of monitoring

Draw water cultures, endotoxin & AAMI analysis as soon as possible.

• Obtain approval from Medical Director

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Re-opening Facility

• Dialysis Machines

1. Chemically disinfect dialysis machines & rinse

2. Perform self test & function check

• Inventory

• Physical Plant

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City Water Quality

• Contact water department to assess status of municipal water.

• Outage for how long ?

• Under a Boil Water Alert ?

• Any increase in chemical additives ?

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Generators – important points to remember• Secure a primary & secondary electrician

• Proper sizing is critical - kW

• Voltage & amperage load determined

• Contract with fuel vendor – fuel additives

• Automatic Transfer switches recommended

• Periodic maintenance performed

• Test operations under full load periodically

• Establish security services

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Communication with Utility Companies

• Have you established contact yet ?

• Is there a dedicated Account Manager or Customer Service rep for the facility ?

• Does the facility have a restoration priority ?

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Emergency Water Supply• Water Tanker filled with potable water – verify source

• Tanker used for food grade hauling

• Ensure water is from a reliable water source

• Hose connections after the backflow preventer

• Water from tanker may need to be pressurized (transfer pump)

• If tanker cannot be left on site, make arrangements for a suitable storage system

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Water Tanker Hookup

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Emergency Water Hookup

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Additional Resources• AAMI - RD52 / RD62 Documents

• CDC - Technical Considerations When Bringing Hemodialysis Facilities Water Systems Back on Line After a Disaster

• CDC - Guidelines for Dialysis Care Providers on Boil Water Advisories

• FDA - Tips about Medical Devices and Hurricane Disasters

• CDC - Safe Use of Tanker Water for Dialysis

• CMS - Emergency Preparedness for Dialysis Facilities – A Guide for Chronic Dialysis Facilities

• OSHA – Fact Sheet

• TEEC – Texas ESRD Emergency Coalition

• KCER – Kidney Coalition for Early Response

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Lessons Learned

1. Communication – daily calls ( internal & external )

2. Contracts established – primary & secondary

3. Take care of relief staffing needs

4. Plan staggered relief schedules

5. Emergency cash

6. Don’t be afraid to ask for help !