1. 1 Practical Tips to Emergency Preparedness John Dahlin CHT, CWS-1 Texas ESRD Emergency Coalition

2. 2 Objectives 1. Outline the basic technical information for disaster preparedness. 2. Review preparation & response activities. 3. Discuss lessons learned from previous disaster events.

3. 3 Staff - Personal Preparations Ensure that your staff have their own family disaster plans. Update phone & contact information.

4. 4 Physical Plant Contact landlords Exercise / test emergency equipment Boarding of exterior windows

5. 5 Physical Plant - continued Turn off water main Turn off city water booster pump Sandbag entryways

6. 6 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

7. 7 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.

8. 8 Water & Concentrate Systems Reverse Osmosis Machines Distribution Systems Concentrate Prep Loops

9. 9 Inventory Place inventory items as high as possible onto pallets & shelving. Evaluate and ensure that the stockroom & supplies are usable and not damaged.

10. 10 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.

11. 11 Assessments Verify utilities are operable 1. Electricity 2. Water 3. Sewer Notify Management of findings Take pictures of damage identified

12. 12 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

13. 13 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

14. 14 Re-opening Facility Dialysis Machines 1. Chemically disinfect dialysis machines & rinse 2. Perform self test & function check Inventory Physical Plant

15. 15 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 ?

16. 16 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

17. 17 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 ?

18. 18 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

19. 19 Water Tanker Hookup

20. 20 Emergency Water Hookup

21. 21 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

22. 22 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. Don’t be afraid to ask for help !