A year ago, 12 hemodialysis nurses started their new roles as members of the provincially-trained Hemodialysis Emergency Support Team (HEST). Since then, they have successfully responded to several emergencies around BC and contributed to vital emergency planning and everyday mentoring. In responding to emergencies, they have supported frontline staff under pressure and ensured life-sustaining hemodialysis treatment for kidney patients. In planning and mentoring, they have strengthened their regional renal programs and the health system as a whole.
“I am appreciative of and impressed by the HEST program,” says Laura Bennet, patient partner with BC Renal and Northern Health. ”It is comforting to know that real plans to deal with the crisis are being developed. Being prepared is the best way to save lives.”
An initiative of BC Renal and the regional health authorities, the HEST nurses were trained to use nursing and coordinating skills to prepare for, and quickly respond to, a variety of regional and province-wide emergencies.
Julia Caryk is a clinical nurse educator with the Island Health Renal Program and says Island Health’s HEST nurses, “significantly bolster our emergency planning and disaster response education for both staff and patients…They have provided in-services and drills for staff, engaged with patients, clarified instructions, improved emergency planning supplies, and created visual presentations to help improve overall awareness.”
Julia adds that a special project has been preparing for rapid response to a potential tsunami in Port Alberni, and that for Emergency Preparedness Month in May, HEST nurses have played a pivotal role in sharing BC Renal’s resources, helping connect patients and staff with the tools BC Renal has built specifically to renal care needs.
In 2024-25, HEST nurses around the province managed a number of regional emergencies, from climate change crises to serious disruptions of equipment, facilities and transportation systems.
In January, when an equipment failure occurred at a Fraser Health hemodialysis unit with the reverse osmosis system that purifies water, services were disrupted in a fully booked system.
Sarah Thomas is the provincial lead for HEST and explains, “Without purified water, dialysis treatments cannot safely proceed.” She says in this case, immediate halting of treatments, activation of emergency protocols, and rapid coordination of patient transfers became necessary.
Diverting patients to other dialysis units during emergencies like this introduces further challenges, including disrupted care routines, extended travel times, and capacity pressures at receiving sites. Sarah adds, “Without expert coordination, patient safety and peace of mind can quickly be compromised — making the role of HEST nurses crucial.”
Elaine Aure is the executive director of the Fraser Health Renal Program. She says from her perspective, “Having the HEST nurses provincially helps health authority renal programs in BC be better prepared to deliver treatment in case of emergency. In Fraser Health, having this role has been beneficial to both staff and patients.”
Equipment failure of reverse osmosis systems is not uncommon, and a few similar incidents occurred in 2024-25 around the province, with HEST nurses stepping in to assist.
Another example of the team’s impact also occurred at the beginning of the year, when the Bennett Bridge in Kelowna was closed for over 10 hours due to a bomb threat, severely disrupting transportation and limiting access to essential dialysis services. Sarah explains that HEST nurses quickly mobilized, ensuring no patient missed their life-sustaining treatments. Patients were rerouted to the Penticton dialysis unit, while others were transported by boat across Okanagan Lake to Kelowna General Hospital.
“This well-coordinated response highlighted HEST ability to swiftly organize patient logistics, support frontline teams, and maintain continuity of care during unexpected crises,” says Sarah.
Laura Dicer who’s a HEST nurse for Interior Health adds that a lot was learned about taking a patient’s perspective into consideration. She says the bomb threat taught team members and staff that rerouting patients in an emergency situation isn’t always black and white: “From our perspective we had offered a reasonable alternative to receive their life-saving treatment, but through the patient’s eyes there was more to it than that.”
Laura adds, “The fear of the unknown, dealing with unfamiliar staff, the fear of things going wrong, all these factors played a role in whether this patient was even going to show up or not. By staff hearing the patient’s concerns and addressing them, the patient felt confident enough to come in, and received their treatment.”
Another kind of emergency took place in March when a sink above the Victoria Community Dialysis Unit overflowed, flooding the unit, and a full diversion of patients to the Royal Jubilee Hospital was required. “HEST nurses with Island Health coordinated the transition, and their leadership allowed frontline staff to continue focusing on patient care while HEST managed the complex logistics of emergency patient reallocation,” says Sarah.
As we enter wildfire season, HEST nurses have been proactively preparing to safeguard dialysis patients who are among the most vulnerable during environmental emergencies. Drawing on lessons from past crises, the team is working closely with dialysis units across the province to review and strengthen emergency response plans, ensuring that evacuation protocols, patient triage systems, and communication pathways are ready for rapid activation. HEST nurses are also identifying high-risk patients who may require early relocation or additional support if evacuation orders are issued.
Dr. Claire Harris is a nephrologist with Vancouver Coastal Health and says, “The HEST nurse role at Vancouver General Hospital has been extremely valuable to advance our local emergency preparedness planning and to improve staff education in this critical area. Our HEST nurse has developed new resources, collaborated with biomedical engineering, nursing, leadership, and renal techs to improve our ability to respond to emergencies.”
Dr. Harris adds, “The HEST nurse collaboration across the province has also added strength to the bonds of our wider hemodialysis community from the nursing lens.” In terms of the overall value of the Hemodialysis Emergency Support Teams nurses, she says, “The HEST nurse role is a worthy cause for ongoing investment across the BC Renal programs.”
