Answer: The recent terrorist attacks in the United States have prompted the evaluation of how we individually and collectively should respond to a disaster if one were to occur in a local area. This is particularly important for healthcare providers whose services would be under increased demand in the setting of a disaster. These services could lessen the toll of any unexpected disaster. Obviously, the ability to deliver such services in a disaster may be compromised by damage to the facilities, power and communications infrastructure. Thus, the providers would have to use whatever means are at their disposal to discover where their services are needed, transport to the site and use available resources to offer care.

In the case of healthcare providers to patients with end-stage renal disease, a need will exist in the case of an emergency for ongoing dialysis treatments. All Medicare-certified dialysis facilities are required to have a disaster plan which includes the education of patients in terms of how to respond in the event of an emergency. Most dialysis facilities have the necessary equipment to provide electrical power in the event of a power failure and many have storage tanks for purified water. Dialysis facility personnel should be familiar with the unit's disaster plan, including the provision for back-up by another facility in the event that the unit cannot operate. Nephrologists should be available to assist at a facility that has been affected by a disaster. However, it is likely that the services of nephrologists will be in higher demand at hospitals where patients directly affected by the disaster are at risk for acute renal failure, fluid and electrolyte disorders. Each nephrologist should be sure that all hospital and dialysis facilities with which he/she is affiliated have multiple mechanisms for contact including pager, cell phone, home phone, office phone and e-mail.

The recent threat of bioterrorism has caused patients and healthcare workers alike to question whether they should have supplies of antibiotics available in case there is an exposure to a biologic agent. The current consensus from national medical organizations is that this is unnecessary and may even be dangerous, as the inappropriate use of such antibiotics may lead to resistant strains of the biologic agent and may divert limited supplies of the antibiotics from the victims who actually need them. For the time being, caution in the handling of suspicious mail and other unknown substances is the best approach to bioterrorism and healthcare providers should obviously be even more conscientious in observing universal precautions to avoid exposure to, and the spread of, infectious diseases.

Answer provided by Jay Wish, MD. Dr. Wish is a Professor of Medicine in the Division of Nephrology at University Hospital of Cleveland. He is also a member of the AAKP Medical Advisory Board.

The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted.

This article originally appeared in November 2001 aakpRENALIFE, Vol. 17, No. 3.

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