Natural Disasters in the Americas, Dialysis Patients, and Implications for Emergency Planning

A Systematic Review

Rashida S. Smith, MPH; Robert J. Zucker, MPH; Rosemary Frasso, PhD, CPH

Disclosures

Prev Chronic Dis. 2020;17(6):e42 

In This Article

Abstract and Introduction

Abstract

Introduction: Natural hazards are elements of the physical environment caused by forces extraneous to human intervention and may be harmful to human beings. Natural hazards, such as weather events, can lead to natural disasters, which are serious societal disruptions that can disrupt dialysis provision, a life-threatening event for dialysis-dependent people. The adverse outcomes associated with missed dialysis sessions are likely exacerbated in island settings, where health care resources and emergency procedures are limited. The effect of natural disasters on dialysis patients living in geographically vulnerable areas such as the Cayman Islands is largely understudied. To inform predisaster interventions, we systematically reviewed studies examining the effects of disasters on dialysis patients and discussed the implications for emergency preparedness in the Cayman Islands.

Methods: Two reviewers independently screened 434 titles and abstracts from PubMed, Scopus, CINAHL, and Cochrane Library. We included studies if they were original research articles published in English from 2009 to 2019 and conducted in the Americas.

Results: Our search yielded 15 relevant articles, which we included in the final analysis. Results showed that disasters have both direct and indirect effects on dialysis patients. Lack of electricity, clean water, and transportation, and closure of dialysis centers can disrupt dialysis care, lead to missed dialysis sessions, and increase the number of hospitalizations and use of the emergency department. Additionally, disasters can exacerbate depression and lead to posttraumatic stress disorder among dialysis patients.

Conclusion: To our knowledge, this systematic review is the first study that presents a synthesis of the scientific literature on the effects of disasters on dialysis populations. The indirect and direct effects of disasters on dialysis patients highlight the need for predisaster interventions at the patient and health care system levels. Particularly, educating patients about an emergency renal diet and offering early dialysis can help to mitigate the negative effects of disasters.

Introduction

Natural hazards are elements of the physical environment that are caused by forces extraneous to human intervention and may be harmful to human beings. Natural hazards, such as weather events, can lead to natural disasters (hereinafter referred to as disasters), which are serious societal disruptions. Disasters can lead to disruption of dialysis provision, a life-threatening event for dialysis-dependent people. People with end-stage renal disease (ESRD) who are dialysis-dependent constitute a medically vulnerable population with high rates of health care use, morbidity, and mortality.[1–3] Missed dialysis sessions exacerbate these adverse outcomes and correlate with a higher patient-perceived burden of kidney disease, higher mortality and hospitalization rates, increased emergency department (ED) visits, and worse general and mental health.[4–7]

Disasters can affect access to dialysis by disrupting transportation, electricity, and water supply.[8] Lack of transportation can leave dialysis patients immobile and unable to receive treatment. Similarly, loss of electricity and contamination of water systems can force dialysis centers to close, requiring dialysis patients to seek care elsewhere or miss treatments.[9,10] The immediate threats from disasters are compounded by long-term stressors and mental health effects.[11]

Just 577 miles south of Florida, the Cayman Islands is home to more than 68,000 people[12] and has more than 2 million visitors annually.[13] As of 2018, the Cayman Islands had 4.1 physicians per 1,000 residents and fewer than 250 inpatient hospital beds.[14,15] In addition to government health care services, the Cayman Islands have 100 private health care facilities (most of which are outpatient clinics) and 2 private hospitals; both hospitals are located on Grand Cayman, although neither provides dialysis services nor operates an ED.[15] Hurricanes can disrupt dialysis provision, and dialysis patients may be flown overseas to receive care.[16] However, patient transport is costly, and the dialysis population is growing; therefore, effective emergency preparedness programs are important in the Cayman Islands and other island settings.

The effect of disasters on dialysis patients living in geographically vulnerable areas such as the Cayman Islands is largely understudied. The objective of this systematic review was to describe the scope and effects of disasters on dialysis patients and the unique needs of dialysis patients during and after a disaster, to inform planning and effective emergency preparedness.

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