Fires May Threaten Patients With Chronic Conditions
California wildfires may make it harder for some patients to get needed care.
Oct. 23, 2007— -- For many patients of Southern California who suffer from chronic health conditions, maintaining routine care may be easier said than done in the face of wildfires that continue to rage in the region.
But for kidney patients, getting needed care could literally mean life or death.
People with severe kidney damage need frequent dialysis to clean their blood -- a procedure which usually must be performed in a medical setting, not at home. Patients who do not get regular dialysis are at risk for severe health consequences, including fluid build up and hospitalization.
And the impact of the wildfires on medical services may make this necessary care harder to come by.
Six hospitals in the region of the wildfires have told ABCNEWS.com that they are accommodating patients from other hospitals who have been evacuated. So far, the system appears to be working; no instances of overcrowding have yet been reported.
But reports from some dialysis centers in Southern California suggest that the fires are disrupting services for a number of kidney patients.
Gaby Enriquez, a spokeswoman for the San Diego dialysis center, said some of the facility's patients have been unable to get to the clinic because of closed freeways. Employees at some other dialysis centers are being forced to evacuate their homes and cannot work.
And since dialysis requires a power and water supply, disruptions to either of these services could have major consequences for dialysis centers and the patients they treat.
Dr. Lee Hamm, chief of nephrology and hypertension at Tulane University School of Medicine in New Orleans has a unique perspective on the care of kidney patients during a disaster.
During the first five days of the Katrina aftermath in New Orleans, Hamm was in Tulane hospital administering dialysis. And a chain of circumstances brought on by the disaster made the efforts of his team all the more difficult.
"Dialysis machines are dependent on power and a good water supply," he says. "But during that disaster, the emergency power went out, and even before then, the water system went out.
"In short, we could not dialyze the patients."
Fortunately, doctors at the hospital were able to control the levels of toxins in the patients' bodies by controlling their food and fluid intake. This, along with constant monitoring, likely saved the patients under Hamm's care. "There were few if any that died from lack of dialysis," he notes.
But for the patients who could not make it to the dialysis machines, the prognosis was likely far bleaker.
"It's not like after the disaster was over these patients could just return back where they were," Hamm says.
And California could be facing a situation similar to that seen in New Orleans in this regard. Already, estimates of the number of residents who have been evacuated have climbed as high as 750,000.
"Many thousands of patients have been displaced from their homes, and as a result, [have lost] access to medical care," says Dr. Matthew Weir, head of nephrology at the University of Maryland Medical Center in Baltimore.
"From a simple standpoint, you may have patients who had all their medicines at home, but had to leave their home. If they are unable to have access to their home, you run into the issue of how to get these patients the prescriptions they need."
Fortunately, there are some significant differences between the current situation in California and the one in New Orleans two years ago that may help medical workers avoid the problems of the past.
"The issues with Katrina were problems that were much more vast in scope," Weir says. "In New Orleans, there was so much injury within the city, and really the next available centers were 70, 80 or even 100 miles away. It really overwhelmed the system.
"I think in general, unless we start to have routes that are closed, the overflow will have access to medical care. ... There is a fair amount of resiliency and flexibility in the system."
Along with access issues, the ability of medical centers to maintain communication with one another may be key in avoiding another Katrina-type health disaster.
"One of the problems that we had was a lack of logistics at the time and very poor communication," Hamm recalls. "We couldn't arrange things very well or let people know what to do to help us."
And along with communication, coordination in the delivery of services to patients who have been displaced is also a priority. This was one of the lessons learned from the aftermath of hurricane Katrina, says Dr. Alicia Neu, medical director of pediatric dialysis and renal transplantation at the Johns Hopkins University School of Medicine in Baltimore.
"Following Katrina, the nephrology community recognized that the inability to provide timely evacuation and the failure of pre-identified emergency facilities greatly increased the morbidity and mortality faced by patients with end-stage kidney disease," she says. "For those patients on dialysis, an inability to receive their treatment means almost certain death. For those patients with kidney transplants, the inability to take their medications regularly meant almost certain rejection of their transplanted organs."
In response to this, Neu and others formed the Kidney Community Emergency Response Coalition, which devoted itself to devising an emergency response system and national preparedness plan for kidney patients.
Still, for medical workers, the California wildfires may still present some issues reminiscent of those seen during past disasters, like Katrina.
"There are also probably many of the same issues," Hamm says. "Doctors will be trying to deal with a multitude of patients in a sort of chaotic environment."
The best thing kidney patients can do is to ensure they have all their necessary medical documents and medications in order, says Dr. Kevin Krane, chief of clinical nephrology at Tulane University School of Medicine.
"They must be able to communicate with physicians concerning the appropriate contact information," he says. "If a patient has to leave suddenly -- for example, during an evacuation -- that patient must take their medical information and dialysis records."
Other doctors agree that kidney patients would do best to be prepared before evacuating their homes.
"Patients need to know what medicines they need to have with them -- at least enough of a supply to last several days, if not weeks," Hamm says.
"They need to be prepared as best as possible," Weir adds. "People under these circumstances need to realize that even though you never expect an earthquake or fires, these things do happen in California."
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