Practical Tips to Emergency Preparedness

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Practical Tips to Emergency Preparedness

• John Dahlin CHT, CWS-1
• Texas ESRD Emergency Coalition

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Objectives

• 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. Dont be afraid to ask for help !