Part One: Striving to Prepare with the Texas ESRD Emergency Coalition

The Texas ESRD Emergency Coalition (TEEC) was established in 2005 after the devastating affects of hurricanes Katrina and Rita on the end-stage renal disease  (ESRD) community.  TEEC is comprised of a broad-based stakeholder group all with the same mission: to facilitate the provision of quality care to people with ESRD in the event of an emergency that negatively impacts the delivery of dialysis and transplant services.  All TEEC steering committee members have different experiences, but all are dedicated to achieving the mission of TEEC.  Here is a story of Karen Walton, and what inspired her to be involved with TEEC.

As a dialysis nurse I received an education in emergency preparedness that will stay with me forever.  I participated in direct patient care in Baton Rouge, La. after the evacuation of medical needs patients, including my beloved dialysis patients from New Orleans.  Nothing could have prepared me for the devastation I observed and the stories I heard.

I went to Baton Rouge with a team of nurses that worked for me.  All of us had moved on to less clinical roles and did not routinely work “the floor” as we so fondly call it.  I myself was then, and still am, a vice president in charge of Quality and Regulatory Outcomes and my staff were internal auditors.  Having said this, you might wonder what we could do to help.  There were times I wondered that myself, however, I did possess a valid nursing license and a strong desire and heartfelt duty to help in any way possible. 

My staff and I arrived in Baton Rouge about four days after the evacuation from New Orleans started. We were greeted by fatigued staff working around the clock in the only dialysis center open for business.  The nursing manager was amazing, working with many unknowns, the worst of which—not knowing when new staff was coming and where they were coming from.  Additionally, she was tasked with finding out our skill levels immediately upon meeting us.  It felt and looked like what I imagine a war zone would—waiting for causalities and replacement troops.

We, the new recruits, did not know where we would sleep as there were no hotel rooms available, and certainly did not know what was in store for us for the next seven days.  We settled in to work.  Buses came and dropped off patients; we set up, primed, assessed, and delivered care.  All the while wondering what was in store for these patients as they moved on down the road to another city.  Many of these patients had not dialyzed for nearly a week and many had not eaten much, if anything.  Most did not have their medications or, as in the case of many I spoke to, had their medications stolen while in the evacuation center.  One even had his artificial leg stolen!  Where and when we would eventually sleep did not seem so important.

As the days went by, we settled into shifts and a type of numbness settled in as well.  The patients delivered to the doorway became sicker and the unit became a large acute dialysis unit, at times with chest pain cared for, wound care delivered, catheter sites cleaned as best as possible given the degree of lacking personal hygiene due to lack of bathing facilities.  One patient had a stroke while in the unit and many were cared for that had been evacuated from hospital settings with IVs, temporary catheters, etc.  I found my acute background both helpful and frustrating as I recognized the degree of care we could not possibly deliver.  We were able, however, to give two to three hours of dialysis to each patient prior to moving them on down the road.  Additionally, we gave each patient a snack from our food supplies:  half a sandwich, a piece of fruit, a cookie and a glass of water-for some this was the first food in several days.

Lessons learned to bring back to my company were many, and while many new policies were implemented, I’m not sure we will ever truly understand the impact preparedness and attention to instructions to evacuate will have on overall better outcomes.  Many of the patients I cared for were woefully prepared-no medications, orders, medical information came with them.  Additionally, many were poor historians with a lack of knowledge of their bodies and their personal situations.  They had lost or become separated from their loved ones who also served as their voice for their health care.

Because of Katrina, Rita was a better experience as we strove in Texas to become more organized and better prepared as a dialysis community.  It was still a struggle as these storms will always be, but working together, I believe our patients received care much faster and were recognized as having special health care needs much sooner than in Katrina.

I am proud of what we (my staff and I did) in Baton Rouge despite the tiredness in my bones and the horrible stories I heard.  It made me connect with a group of people on a much grander level and understand, as all nurses innately do, that it’s about what we can do for the patient and not about organizations and employers.

TEEC has resources for patients and providers as well as a newly released disaster preparedness video for patients on their website at www.texasteec.org.  Although most materials are Texas specific, they can be adapted to fit your needs.  Look for a full article on TEEC will when it appears in the October 2012 issue of Renal Business Today. 

Karen Walton, RN, BSN, CNN is the vice president of Clinical Operations for US Renal Care.