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End-stage renal disease use in hurricane-prone areas: should nephrologists increase the utilization of peritoneal dialysis?

Hurricane Katrina resulted in massive destruction of the gulf coast of the United States in 2005. In the immediate aftermath, displaced dialysis patients required urgent hemodialysis or additional peritoneal dialysis (PD) supplies. Massive damage to the health care infrastructure in these communities disrupted dialysis services for several months. As a result of this event and subsequent storms during the 2005 Atlantic hurricane season, many decisions regarding future services to dialysis patients in hurricane prone communities (HPCs) need to occur. Nephrologists, dialysis nurses, dialysis providers, and patients need to discuss the ramifications of and types of continued dialysis services in HPC. Nephrologists should encourage PD, and efforts to educate on other renal replacement therapies including PD and transplant should occur. With the potential for interruption of electrical, sewerage, and water services, more patients should consider PD. Recovery from future events begins with appropriate disaster planning. Many questions are considered and need answering in planning for dialysis services in HPC and other communities subject to natural disasters. This summary provides the basis to begin discussions when planning for dialysis services in communities prone to natural disasters.

Community Networks↗

Organising and planning for a disaster.

Disasters affect people, communities, domestic animals and native fauna and often inflict damage to property, injury and loss of life. Australia has been relatively fortunate in this regard; nonetheless we must plan disaster procedures.

Australia↗

The ABC's of disaster response.

The readiness of our healthcare facilities to respond to terrorist acts or naturally occurring epidemics and disasters has been at the center of public attention since September 11, 2001. The many other tragic events that have occurred throughout the world since then further reinforce the need for all healthcare facilities and medical personnel to increase their level of preparedness if they wish to optimize outcomes. Maximizing survival rates and minimizing disability during any MCI hinges on rapid, seamless, and coordinated response between first responders and first receivers. The Incident Command System and the HEICS are organizational tools that form the foundation for such a rapid and coordinated response. The ICS provides a simple and adaptable management structure that is capable of being expanded or contracted to meet the needs of a specific situation. The HEICS adapts the ICS into the hospital setting and, in addition to the benefits stated above; its use of the ICS nomenclature and terminology facilitates the communication and the sharing of resources between all agencies and health care institutions involved. A basic knowledge and understanding of the ICS principles and structure is essential for all individuals participating in a disaster response. Previous efforts at disaster preparedness have focused predominantly on the pre-hospital and rescue phase of the disaster response, but a complete and coordinated community response requires creation of integrated disaster plans. True readiness can only be achieved by testing and modifying these plans through integrated simulation drills and table top exercises. Hospital-wide drills are essential to educate all staff members as to their institutional plan and serve as the only substitute at present to first hand experience. At present, there is no evidence-based literature to define what constitutes the best medical response by medical personnel within a disaster setting. This information will likely evolve over the next several decades as we now recognize Disaster Medicine as a separate scientific and medical entity. In the interim, we can develop and modify our response plans based on the "lessons learned" from past experience. Prior events have demonstrated that general surgeons and surgical subspecialists are critical components to a successful hospital response for the vast majority of all mass casualty incidents. Thus, surgeons must take responsibility for increasing their knowledge and understanding of basic disaster management principles and must play an active role in developing their institutional disaster plans.

Disaster Planning↗

Hospitals and disasters: how they fared; what they learned.

Disasters happen, be they nature-driven like a tornado, hurricane, or ice storm; accidents like plane crashes or train wrecks; or failures or defects in critical power systems. When they do take place and your hospital is called on to respond, a well-thought-out disaster plan, augmented by regular drills, can save the day. But, as we have reported in our coverage of many major disasters over the years, no plan covers all eventualities and there is always some unforeseen challenge that has to be overcome and incorporated into future plans. In this report, we'll give details of how hospitals and their security officials responded to an external disaster and an internal situation that was potentially disastrous, and what these real-life events taught them.

Disaster Planning↗

Chemical warfare: disaster preparation in an Israeli hospital.

The situation in the Middle East makes it imperative that Israeli hospitals be prepared for disaster, particularly that associated with chemical warfare. To prepare for the impact of chemical warfare, Israeli hospitals have designed mass trauma programs, which include staff training and simulated disaster drill exercises. These have been incorporated in the conventional disaster program since 1989. This article provides a brief overview of the trauma program at Beilinson Medical Center in Petach Tikva, Israel, including definition of four stages of injury, guidelines for intervention, and a discussion of the role of the social worker in the disaster plan.

Adult↗

Mass casualty incident. Integration with prehospital care.

Mass casualty incident involves the use of limited resources for multiple casualties. The emergency physician must be familiar with both prehospital and hospital plans for mass casualty care in order to facilitate optimal care and to maintain the continuum from field care to definitive treatment. It is essential that the emergency physician become involved in the disaster planning processes to ensure that the victims receive the best care available under the circumstances and that the safety and emotional well-being of both prehospital and hospital personnel are assured. Emergency physicians involved in prehospital care should be certain that the local EMS system has adequate training and chances to update their skills and knowledge. Disaster drills of the EMS system are excellent ways to practice, to identify weaknesses, and for preplanning to enhance disaster medical care.

Disaster Planning↗

Helicopter emergency medical services roles in disaster operations.

Rotor-wing aircraft have previously proven utility in disaster operations, but recent expert reviewers have identified areas of potential improvement in integration of helicopter emergency medical services (HEMS) resources into disaster planning and management. This paper discusses salient points regarding helicopter operations in disaster management, using prior reports regarding rotor-wing aircraft utilization as a basis upon which to provide a concise review of HEMS operations in disasters.

Air Ambulances↗

Prepared for the unthinkable: EDs respond to terrorist attacks.

The response to the terrorist attacks at the World Trade Center and the Pentagon provided many key lessons for disaster preparedness. Volunteer physicians were not used in most cases, but EDs recognized the need for a system to check credentials. Communication from disater sites was problem. Injured patients went to the nearest hospital, even if it was not the most appropriate hospital. Experts recommend using existing disaster plans as templates to design or update your own.

Aircraft↗

Prior planning to avoid responders becoming "victims" during disasters.

Prior planning to meet the physical and mental needs of medical and emergency services responder, is a practical measure to reduce staff stress. This has the potential to improve both the operational efficiency of a disaster response and reduce the incidence of post-traumatic stress disorders in responders. Research is needed to define which interventions provide the greatest benefits to local responders.

Adaptation, Psychological↗

Planning an airport disaster drill.

The authors have prepared this paper to serve as a guide for planning airport disaster drills, particularly at the major air carrier airports. Their recommendations are subject to change according to the needs of the individual airport and the particular circumstances that may be present. Basically, the recommendations are founded on the experience gained by participation in planning and carrying out five separate emergency or disaster drills (Oakland International Airport 1, San Francisco International Airport 2, Los Angeles International Airport 2). The authors also have been involved in a total of three additional disaster drills in California and have been involved in one way or another in an additional 19 airport disaster drills throughout the United States. The presentation is divided into segments according to activity. However, it should be noted that there is a cohesiveness necessary for disaster planning if the drill is to be successful.

Aerospace Medicine↗