Personal disaster preparedness of dialysis patients in North Carolina

Abstract

Background and objectives: Dialysis patients are among the most vulnerable patients during a disaster because they are sensitive to a lapse in treatment. Although thorough preparation could mitigate disaster effects, we hypothesized that dialysis patients' personal and medical disaster preparedness was inadequate.

Design, setting, participants, & measurements: This prevalence study surveyed mentally competent adults requiring care at six regional dialysis centers. We asked questions regarding demographics, general disaster preparedness utilizing Homeland Security recommended item lists, dialysis-specific preparation for an individual to shelter in place, and preparatory steps for a forced evacuation. To determine if preparedness differed by demographic variables (gender, race, age, and education) chi-squared tests were used.

Results: Four hundred forty-two patients were approached, and 311 (70%) completed the survey. Participants were 54% male, 60% black, average age was 58 (± 15) years, and although 79% completed high school, 50% of our sample had marginal or low health literacy. Although all units had a disaster preparedness program in place, the general disaster preparedness of most participants was poor. Age, gender, race, education, literacy, and socioeconomic status did not affect general disaster preparedness. However, home peritoneal dialysis patients were significantly more likely to be prepared for a disaster compared with hemodialysis patients. No other significant associations were noted.

Conclusions: Irrespective of sociodemographic characteristics, most subjects were unprepared for a disaster. Dialysis patients were poorly prepared to shelter in place or to evacuate in the face of a disaster. Education regarding personal and dialysis-specific disaster preparedness is warranted.

Figure 1.

General disaster preparedness was assessed using the 15-item list established by the Department of Homeland Security. We also asked whether all of the recommended items were together in a bag ready to evacuate. General disaster preparedness was inadequate. Only 169 (54%) respondents stored ample food and water according to published guidelines, 152 (49%) stored 75% of checklist items, and 94 (31%) stored all items in a bag or kit for easy retrieval during disaster.

Figure 2.

Dialysis-specific preparedness for forced evacuation revealed that 244 (80%) of respondents had insurance information and a listing of their medications accessible in case of forced evacuation. Only 129 (43%) knew of alternative dialysis centers and 128 (42%) had sufficient medical records at home to provide a dialysis center with treatment information. Although most had friends or family to stay with during a disaster, only 121 (40%) had explicitly discussed this possibility with their friend or relative. Lastly, 47 people (15%) had an identifier that they could wear such as a bracelet or a necklace to alert health care providers of their chronic conditions.

Figure 3.

Dialysis-specific preparedness to shelter in place demonstrated that although more than half (169 [63%]) maintained an extra supply of medicines and 177 (57%) understood a renal emergency diet, only 19 (6%) respondents had a potassium-binding resin at home.