Troubleshooting in Disaster Zones

Planning, Partnerships, and New Devices to Help Kidney Patients

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The one-two punch of Hurricanes Irma and Maria in the United States and the Caribbean in 2017 was a wake-up call to the nephrology community and first responders. The twin disasters left more than 56,000 dialysis patients in the lurch, and kidney transplant patients in destroyed communities desperately seeking immunosuppressive medications.

To better prepare for future disasters, ASN created the Emergency Partnership Initiative (EPI), which held its first meeting in September 2019. The partnership aims to bring together dialysis and transplant clinicians; patients; federal, state, and local emergency responders; public health leaders; and companies that make up the supply chain to anticipate and prepare for kidney patients’ needs in future disasters, said Nicole Lurie, MD, chair of the EPI and former Health and Human Services (HHS) Assistant Secretary for Preparedness and Response.

“It comes very much out of the experience of ASN members who have been called upon or found themselves in disaster situations where the system broke down for patients,” Lurie explained. The EPI, she said, is working to anticipate such problems and be proactive in working with partners to support patients, clinicians, and first responders before and when disasters strike.

One of the challenges during hurricanes and other disasters is that dialysis patients may be displaced from their homes and usual care providers. Other providers may be unable to handle the surge of patients or may be incapacitated by the disaster.

“You have to be able to anticipate that and have a plan for how you’re going to deal with it so that people don’t get into even more emergency situations,” Lurie said. “Then, when the crisis is over, to the extent that it’s possible, you need to get patients back into their regular routine.”

That process starts with knowing who the dialysis patients are and how to reach them in an emergency, knowing how much surge capacity dialysis providers have, and preparing to provide additional dialysis as needed. To help expand capacity, HHS recently awarded a contract to Outset Medical (San Jose, CA). HHS will purchase Tablo Hemodialysis Systems devices and supplies to deploy in communities experiencing a disaster. The portable devices have received US Food and Drug Administration clearance for center-based use. Outset Medical has already delivered 25 of the 50 machines ordered by HHS and expects to deliver the other half by the end of the year.

Outset Medical CEO Leslie Trigg said that during recent disasters there was limited access to dialysis in the affected communities and many patients on dialysis were temporarily relocated to other cities across the US for weeks or months. The situation takes a psychological toll on patients and their families and is also costly for the government, she noted. To curb these costs and allow patients to stay close to home, the HHS put out a request for proposal for devices that could more easily be used in communities affected by disasters and Tablo was selected. Tablo doesn’t require as much infrastructure as other systems, Trigg said. The device only requires a plug and tap water and can handle tap water with a wide range of characteristics, she said.

“I think they chose Tablo for its flexibility,” Trigg said. “It offers a lot more options about where patients can be treated in the affected areas.”

Lurie said she’s glad both the HHS and EPI are considering patients’ experiences in their disaster planning.

“I'm very excited that we have some forward thinking and proactive thinking about dialysis and disasters [through the EPI and HHS’s purchase of Tablo devices],” Lurie said.