Many people living with kidney disease require frequent health care, especially when dialysis is part of their treatment – but emergencies such as wildfires, drought and other disasters can disrupt their access to care. Fortunately, a collaboration of researchers from across Canada have outlined a novel ”disaster roadmap” for how to continue the delivery of care during an emergency. In addition, a published article has provided an update on British Columbia’s novel emergency response team, which was deployed this past summer.
Dr. Caroline Stigant is a nephrologist who wears many hats in advancing planetary health. Among her roles, she’s a clinical associate professor with the University of British Columbia and chair of the Canadian Society of Nephrology's Sustainable Nephrology Action Planning (SNAP) committee. As part of the committee’s efforts, they surveyed care providers across Canada about their knowledge on sustainability practices, including emergency preparedness.
“A striking finding of our survey was that a lot of kidney care providers across Canada were not aware of their centre having a disaster plan,” says Stigant, adding this highlights the need for better communication among staff of existing plans, or the need to develop plans.
This prompted researchers of the SNAP team, led by Dr. Shaifali Sandal of the Research Institute of the McGill University Health Centre, to investigate ways in which kidney care providers around the world have responded to past emergencies. They found 52 relevant academic papers, which were analyzed for key themes.
The resulting disaster roadmap Dr. Sandal’s team developed spans preparedness, response, and recovery, and outlines concrete steps that can be taken by kidney care providers in the event of an emergency.
“While we’ve provided steps for every stage, I want to emphasize that preparedness is really, really key,” says Stigant.
In the Disaster Preparedness stage, the researchers have used an ABC + S acronym to help teach the steps:
A - Assess needs, risks, and vulnerabilities: This includes the risk of regional disasters that may take place, the patients who could be affected, and the quantity of supplies needed to treat them.
B - Building a task force network: It’s recommended to create a network that can collaboratively develop, disseminate, implement, and maintain a coordinated preparedness and response framework.
C - Capacity building: This involves strengthening abilities, processes, and resources to adapt and survive. For example, capacity-building could involve stocking up on tangible resources, such as backup generators, or creating alternative staffing plans, to ensure care can continue during surges in demand. “Contingency planning” and “Coaching of staff” are other “C” steps of preparedness.
S - Strategic partnerships: Partnerships may include local, national-level, and international emergency management agencies, pharmaceutical and medical supply companies.
The full roadmap of their recommendations is published in the Journal of the American Society of Nephrology.
Stigant says the SNAP committee is now working with its diverse network of nephrologists, administrators, nurses, pharmacists and other interest-holders from across the country to begin putting the steps into practice in their respective jurisdictions.
In terms of a jurisdiction in Canada already providing a great example of how to operationalize emergency planning and disaster mitigation, Stigant says, “I think it would be fair to say the rest of the country is learning from British Columbia,” pointing to the work of Sarah Thomas, who has been leading kidney care emergency preparedness plans in the province.
BC’s example
In BC, five regional health authorities provide direct kidney care to adult patients, and BC Children’s Hospital serves kids and teens under the umbrella of the Provincial Health Services Authority (PHSA). Also under PHSA, BC Renal plans and coordinates kidney care across the province.
Thomas, an experienced dialysis nurse and project manager with BC Renal, says the motivation for the preparedness plan began in 2021 – a year when the health-care system was still recovering from the COVID-19 pandemic and struggling with staffing shortages. At the same time, a wave of climate disasters hit, starting with a heat dome and extreme wildfires, followed by major flooding that took out bridges and stretches of highway.
“There was a lot of concern about patients potentially not receiving their dialysis, because they depend on it as a life-sustaining treatment” Thomas explains.
To create BC Renal’s emergency response plan, Thomas and her colleagues first conducted an analysis to identify the most likely climate disasters to disrupt in-centre hemodialysis care in the province (e.g., drought, wildfires), as well as providers’ current capacity to deliver care. Their assessment revealed a lot of renal programs were already at, or over, capacity.
Thomas therefore applied for new funding to hire and train a special team of 12 hemodialysis nurses dedicated to emergency response - a collaboration of BC Renal and the regional health authorities. Each nurse is stationed at one of the outpatient centres across BC, and together they make up the Hemodialysis Emergency Support Team (HEST). Members have dual roles of improving emergency preparedness and care locally and of traveling to different regions as needed.
As part of their preparedness planning, the HEST nurses consulted experts and devised standard protocols to follow when a specific type of crisis occurs. They then tested and improved upon these protocols through pilot exercises and mock drills. A full overview of their approach is published in the Canadian Journal of Kidney Health and Disease.
Thomas notes that, although the HEST nurses have not yet been deployed during a climate emergency, they were sent this past summer to a hemodialysis centre in Kamloops, when a perfect storm of factors (e.g., sick leave, vacation and maternity leave) resulted in severe staffing shortages.
Thomas says the deployment went really well, and not only resulted in significant cost-savings for the health care system, but was also more environmentally friendly, since only nine nurses had to travel to Kamloops, side stepping the need to transport roughly 65 patients to other hemodialysis sites.
“We learned a few lessons, and got really great feedback from staff and patients in the Kamloops area,” Thomas says.
She adds, “I hope the Hemodialysis Emergency Support Team is giving patients a sense of reassurance that this group of nurses is making sure they will be cared for during a crisis, and that staff also have a sense of reassurance, knowing that if there is an emergency, they'll have support from their program leadership.”
