Module 12 — Emergency Planning and Response

Study guide

• Emergency preparedness is an ongoing cycle: plan, equip, train, exercise, respond, recover, and improve. A clinic plan should cover likely hazards in its community, not just fire.Play from here
• The emergency plan should define authority, notification methods, patient/staff accounting, evacuation or shelter-in-place, treatment interruption, transportation, backup clinics, supplies, utilities, records, and recovery.Play from here
• Maintain current contact lists for patients, staff, physicians, emergency services, vendors, utilities, the local ESRD Network, KCER, and nearby/farther backup clinics. Keep paper and electronic copies where one event cannot destroy both.Play from here
• The plan must be accessible to every shift and understandable to new staff. Practice drills, document gaps, and revise the plan after exercises and real events.Play from here
• In a crisis, protect life first; then stabilize treatment and the facility; then communicate, document, and recover. Follow the clinic’s code system and chain of command rather than improvising.Play from here

Why answers are correct

• Dialysis patients are medically dependent on scheduled treatment and may deteriorate when treatment, water, power, transport, or medications are interrupted. A prearranged alternate pathway is safer than making individual decisions during chaos.Play from here
• The best plan is specific enough to guide action but flexible enough for changing hazards, staffing, building damage, and transportation conditions.Play from here

Limitations / traps

• A plan on paper is not readiness. Missing supplies, outdated phone numbers, untrained staff, or an untested backup clinic can turn a good document into a failure.Play from here
• Do not promise that a routine emergency vehicle will provide dialysis transport or that every patient can be treated at the usual time. Capacity and medical orders must be confirmed.Play from here

Clinical pearl / safety

• Know where the emergency plan, evacuation kits, shutoffs, fire extinguishers, first-aid supplies, emergency contacts, and patient census are kept before an event occurs.Play from here

Exam cue

• Preparedness is a continuous process, not a one-time binder. The response starts with life safety and accountability, then continuity of dialysis.Play from here

Study guide

• On discovering an emergency: recognize the hazard, protect yourself, call for help/activate the appropriate code, assess the patient, provide trained first aid or CPR as directed, and notify the nurse/medical director and emergency services as required.Play from here
• Stop or disconnect treatment only according to training and the emergency procedure. Protect the access, control blood loss, preserve the extracorporeal circuit when policy allows, and document what happened and what was done.Play from here
• Examples of clinic emergencies include fire/smoke, medical collapse, blood leak, water or dialysate contamination, electrical failure, severe weather, hazardous-material release, violence, and evacuation.Play from here
• During an evacuation, take the census and essential emergency information if safe, use assigned routes, move patients according to mobility and clinical priority, and account for everyone at the assembly point.Play from here
• Shelter-in-place may be safer than evacuation for some external hazards. Close or isolate the area, control doors and ventilation as directed, monitor patients, and await incident-command instructions.Play from here

Why answers are correct

• A technician’s role is to recognize, call, protect, and perform only trained actions while the licensed team directs clinical decisions. Rapid notification prevents a local problem from becoming a patient-care failure.Play from here

Limitations / traps

• Never re-enter a dangerous area for supplies or a patient without authorization and appropriate responders. Do not silence alarms or restart equipment merely to restore routine.Play from here
• Evacuation routes and assembly locations can be blocked; know an alternate route and never use an elevator when fire or power loss makes it unsafe.Play from here

Clinical pearl / safety

• Maintain a current patient count during movement. A patient left behind, an unreported treatment interruption, or an unrecognized access bleed is an emergency even when the building looks orderly.Play from here

Exam cue

• Personal safety and calling for help precede patient rescue. Then use the facility’s emergency algorithm and document the event.Play from here

Study guide

• Fire response follows the facility’s alarm/evacuation system: activate the alarm, call emergency services, rescue only when safe, contain smoke/fire by closing doors if directed, and evacuate using the assigned route.Play from here
• Know the locations and shutoffs for electricity, gas, water, oxygen, sprinkler systems, and other utilities. Only trained/authorized people should operate them.Play from here
• Power loss can stop dialysis machines, water treatment, lights, HVAC, elevators, phones, and electronic records. Use emergency power and downtime procedures; protect patients from blood loss and unsafe equipment.Play from here
• A chemical spill or unknown odor is a hazard: keep people away, isolate the area, notify the appropriate response team, consult the safety data sheet, and do not clean it without training and proper PPE.Play from here
• After a fire, flood, smoke event, or chemical exposure, equipment and water systems require inspection and release for use. “It turns on” is not a safety clearance.Play from here

Why answers are correct

• Fire, water, electrical, and chemical hazards can injure staff and patients directly and can contaminate dialysis systems. The safest response limits exposure and brings in the right specialists.Play from here

Limitations / traps

• Do not use water on an electrical or chemical fire unless the authorized response procedure says it is appropriate. Do not enter a smoke-filled or structurally compromised area.Play from here
• Emergency responders may not know dialysis-specific needs; identify patients and explain that they are dependent on scheduled treatment.Play from here

Clinical pearl / safety

• Keep oxygen away from ignition sources, secure cylinders, and follow facility rules for oxygen during evacuation.Play from here

Exam cue

• Isolate, alert, evacuate or shelter as directed, and wait for clearance before resuming care.Play from here

Study guide

• Disaster planning considers earthquakes, hurricanes, tornadoes, floods, winter storms, extreme heat, wildfire, earthquakes/structural damage, and prolonged utility or communication failure.Play from here
• Before an anticipated event, secure equipment and supplies, protect records, charge communication devices, confirm staffing and transportation, contact patients, and coordinate with the Network and backup clinics.Play from here
• During evacuation or sheltering, prioritize life-sustaining treatment, keep an accurate census, use the predetermined gathering point, and give responders clear information about dialysis dependence, access type, last treatment, medications, and next treatment needs.Play from here
• Triage sorts patients by illness or injury and urgency. A triage nurse helps determine who needs immediate attention, who can be rescheduled, and where/when treatment should occur. Social work can address psychosocial needs and transport.Play from here
• Patients evacuated without notice may be difficult to locate. Use the plan’s call-in number, local media, gathering place, backup clinics, ESRD Network, KCER, and other approved sources to reconnect patients and staff.Play from here
• For a backup clinic, the medical director supplies emergency prescription orders and the receiving clinic adjusts scheduling to its capacity. Keep records of work performed and supplies borrowed or loaned.Play from here

Why answers are correct

• Triage and a shared census allocate limited treatment and transport capacity to the people at greatest risk while preventing duplicate or missed follow-up.Play from here

Limitations / traps

• Firefighters and ambulances may not be available for routine dialysis transport. Staff should not transport patients in personal vehicles as a workaround.Play from here
• Do not assume a road, bridge, clinic, or shelter is safe because it was safe before the event; conditions change.Play from here

Clinical pearl / safety

• A patient who misses treatment needs prompt clinical follow-up; do not independently alter treatment time, prescription, or access care.Play from here

Exam cue

• In disaster triage, identify dialysis patients to responders and maintain patient tracking from departure through the backup site.Play from here

Study guide

• An infectious outbreak can affect staffing, treatment schedules, isolation needs, supplies, transportation, and access to backup facilities. Use current public-health and CMS guidance plus the clinic infection-control plan.Play from here
• Screen and identify symptomatic or exposed patients according to policy; separate/cohort when directed; use appropriate PPE and hand hygiene; clean and disinfect equipment and surfaces; and report to the nurse/medical director and public-health authorities as required.Play from here
• Preserve continuity without spreading infection: coordinate alternate shifts/sites, transportation, isolation capability, and communications. Staff illness and exposure rules may reduce available personnel.Play from here
• During a pandemic, healthcare “frontline” workers may have a duty to report to work during an active crisis, subject to their facility’s policy and safety requirements. Staff should also have personal/family plans.Play from here

Why answers are correct

• Dialysis brings medically vulnerable patients together repeatedly. Infection-control decisions must protect the whole treatment population while keeping essential therapy available.Play from here

Limitations / traps

• Do not invent isolation rules or reuse PPE outside policy. Current CDC, state, CMS, and facility guidance takes precedence over a textbook example.Play from here

Clinical pearl / safety

• A suspected outbreak is both an infection-control event and a continuity-of-operations event; notify early so staffing and patient routing can be adjusted.Play from here

Exam cue

• Control transmission and preserve treatment capacity at the same time.Play from here

Study guide

• Staff should recognize warning behaviors, threats, escalating conflict, weapons, and unsafe surroundings; know exits, panic buttons, security contacts, and the facility’s response code.Play from here
• For an active threat, the basic priority is run, hide, fight: escape if possible; if not, secure/hide, silence devices, and stay out of sight; fight only as a last resort when life is in immediate danger.Play from here
• Call law enforcement when safe. Give location, description, direction, weapons, injuries, and the number/condition of patients and staff. Do not confront or investigate a threat unnecessarily.Play from here
• After the immediate threat, account for people, provide medical care within training, preserve the scene, support affected patients/staff, and document/report through the appropriate channels.Play from here

Why answers are correct

• Distance, barriers, early warning, and rapid law-enforcement notification reduce exposure. The correct action depends on the threat and available escape route, not on a rigid sequence that ignores circumstances.Play from here

Limitations / traps

• Do not return for belongings or re-enter when responders have not cleared the site. Do not assume a locked treatment area is safe without assessing exits and the threat location.Play from here

Clinical pearl / safety

• Include patients with limited mobility in active-threat and evacuation drills; a plan that assumes everyone can run is incomplete.Play from here

Exam cue

• Run when safe; hide when escape is not safe; fight only to survive.Play from here

Study guide

• Home patients need an emergency plan that covers power, water, supplies, transportation, communication, medication, records, and when to contact the home program or emergency services.Play from here
• CAPD exchanges rely on gravity and may remain possible during a power outage, unlike equipment that requires electricity. The patient must follow the prescribed modality and the home program’s instructions; do not substitute a different treatment independently.Play from here
• Keep an emergency reserve of essential supplies, food, medications, and water as directed by the home program. The module emphasizes planning for about two weeks where feasible and rotating stock so it does not expire.Play from here
• Patients should carry emergency contact information and treatment details, identify alternate dialysis locations, know how to protect the catheter/access, and report contamination, abdominal symptoms, fever, drainage problems, or inability to complete treatment.Play from here

Why answers are correct

• Home patients may be isolated from a clinic during a disaster. Gravity-based CAPD can provide an option when electricity is unavailable, but only if supplies, clean technique, and prescribed instructions remain available.Play from here

Limitations / traps

• “Two weeks of supplies” is a planning target, not permission to change the prescription or delay urgent care. Local program instructions and disaster conditions control.Play from here
• Emergency diet guidance may be more restrictive than a normal renal diet and is temporary; it does not replace dialysis.Play from here

Clinical pearl / safety

• Home patients should contact the home program early when a disaster threatens delivery, refrigeration, water, power, or safe technique.Play from here

Exam cue

• Know which home modality depends on electricity and plan supplies before the event.Play from here

Study guide

• Catastrophes may create staffing shortages. Brief staff at least daily and whenever conditions change; cross-train, create workable shift rotations, and plan for staff transportation, childcare, elder care, pets, food, water, and housing.Play from here
• A clinic may provide food/water, mental-health or Employee Assistance support, transportation help, temporary housing, incentives, and conflict/problem-solving. Administrative continuity includes payroll, billing, vendors, and alternate ways to receive pay.Play from here
• Patient schedules, days, stations, and prescriptions may change. Closed stations or altered prescriptions require appropriate medical direction and orders.Play from here
• Transportation options can include buses, taxis/rideshares, light rail, non-emergency medical transport, volunteers, faith groups, and community agencies. The social worker can coordinate these resources.Play from here
• Use a central call-in number, designated gathering place, patient/staff notification tree, and alternate communication methods when phones or internet fail.Play from here

Why answers are correct

• Continuity depends on people as much as buildings. Supporting staff and giving patients reliable information reduces unsafe improvisation.Play from here

Limitations / traps

• Never assume a message reached every patient. Use more than one communication method and document attempts.Play from here
• Do not change a dialysis prescription because a schedule is inconvenient; a physician/medical director must authorize it.Play from here

Clinical pearl / safety

• Keep a current list of patients needing mobility assistance, language support, caregiver coordination, or special transport.Play from here

Exam cue

• A safe backup plan includes both treatment capacity and a way for patients and staff to reach it.Play from here

Study guide

• Clinic maps should identify exterior doors, potential reunification areas, utility shutoffs, hydrants, sprinkler shutoffs, storm drains/sewers, floor plans, extinguishers, evacuation kits, safety equipment, and dialysis-chair locations. Keep a map for an alternate safe location.Play from here
• Do not enter a damaged building until responders or qualified personnel deem it safe. Use a buddy system; never enter alone. Check the perimeter for downed trees/power lines, gas, water, sinkholes, and other hazards.Play from here
• Warning signs of unsafe structure include fire, fast-moving water/broken pipes, gas odor, bulging walls, collapse, exposed structure, unstable or uneven floors, visible cracks through floors/ceilings, arcing wires, large X-shaped wall cracks, and many broken doors/windows.Play from here
• Form a Damage Assessment Team (DAT) with a clear leader and appropriate staff/outside professionals. Assess electrical, structural, plumbing, information, water, and equipment systems; estimate repair time; protect valuable assets; report to the medical director/charge nurse; coordinate reopening and insurance.Play from here
• A structural engineer must clear the building before treatments resume. Lease and insurance arrangements determine who performs repairs.Play from here

Why answers are correct

• A damaged building can injure people or contaminate care even when the treatment floor appears usable. Assessment must cover structure, utilities, water, equipment, and information systems.Play from here

Limitations / traps

• Do not enter because a patient or supply is inside. Do not reopen based on appearance, power restoration, or a single inspection.Play from here

Clinical pearl / safety

• The biomedical technician should inspect machines and the water-treatment system after smoke, fire, flood, or water damage; flooding may require cultures and specialized cleanup.Play from here

Exam cue

• Clearance precedes re-entry; equipment inspection and water-quality verification precede dialysis.Play from here

Study guide

• A disaster can change water volume and quality. Drinking-water suppliers may stabilize municipal water with treatment, but drinking-water safety does not establish dialysis-water safety. The medical director decides whether water is acceptable for dialysis; an alternate source such as tanker water may be needed.Play from here
• If the water system may be compromised, increase monitoring under CMS/AAMI and facility policy. Check hardness at least each shift (daily minimum) and before/after the softener; check total chlorine before and after the first carbon tank at least hourly; check conductivity before and after RO/DI; and check bacteria and endotoxin/LAL around RO/DI at the required interval (the module describes every 48 hours during this response).Play from here
• Compare current results with pre-disaster readings and previous tests. Keep the system fresh with preventive maintenance such as carbon re-bedding, prefilter replacement, and flushing/cleaning/disinfecting the RO membrane, distribution loop, storage tanks, and machines after a water event.Play from here
• Test for residual disinfectant after disinfection to confirm the system was rinsed. A flooded clinic requires more complex cleanup; use current CDC flood-recovery guidance.Play from here
• For machines: rinse and chemically disinfect as directed; verify residual chemical levels; restore conductivity; run the machine self-test; and repair any machine that fails before use.Play from here

Why answers are correct

• Water contaminants and residual disinfectants can harm patients or equipment. A normal-looking machine or acceptable municipal sample cannot substitute for point-of-use dialysis checks.Play from here

Limitations / traps

• Testing frequency in an emergency does not replace required baseline testing or authorization. Never treat patients until required results, inspections, and medical/facility clearance support restart.Play from here
• Do not assume a machine is safe because it passes power-up; water path, chemical residue, alarms, and self-test all matter.Play from here

Clinical pearl / safety

• When in doubt, stop use of questionable water or equipment, notify the responsible clinical and technical leaders, and document the result and action.Play from here

Exam cue

• After a disaster, verify water and machines at the point of use; do not rely on potable water, visual clarity, or a powered-on display.Play from here

Study guide

• Shock, grief, anger, fear, sadness, worry, and concern for loved ones can be normal after disaster. Seek counseling when symptoms persist or disrupt daily function. A licensed mental-health professional can assess for PTSD and help with a changed “normal.”Play from here
• Possible disaster-related stress signs include sleep or appetite changes, headaches/stomach upset, cold/flu-like symptoms, confusion/disorientation, poor concentration, shortened attention, frustration, mood swings/crying, hopelessness, guilt/self-doubt, depression/anxiety, substance use, fear of crowds/strangers/being alone, withdrawal, and difficulty balancing life.Play from here
• Helpful measures include small manageable goals, avoiding major life changes immediately, deep breathing/relaxation, routine, sleep, exercise, time outdoors, journaling, supportive conversation, patience, healthy food, limiting distressing news, enjoyable activities, and helping others. Avoid alcohol and drugs as coping tools.Play from here
• Healthcare workers may feel guilt about missing work, fear for family safety, distress from life-sustaining care, and strain from long hours or unfamiliar duties. Maintain boundaries, rest, use peer/EAP or crisis support, and seek help when needed.Play from here
• The SAMHSA Disaster Distress Helpline is identified as a confidential 24/7 support resource.Play from here

Why answers are correct

• Emotional effects can impair attention, judgment, sleep, and safe patient care. Supporting staff and patients is part of recovery, not an optional extra.Play from here

Limitations / traps

• Normal stress and serious impairment can overlap. Do not diagnose PTSD or depression yourself; refer concerns to qualified professionals and follow urgent-risk procedures.Play from here

Clinical pearl / safety

• Watch for unsafe fatigue, confusion, escalating distress, or substance use in yourself and coworkers; report through supportive, appropriate channels.Play from here

Exam cue

• Normalize feelings, encourage practical coping and support, and escalate persistent or dangerous symptoms.Play from here

Study guide

• Recovery focuses first on patients and staff, then on safe restoration of treatment. The work may range from cleaning to major repair, renovation, or replacement. Resume treatment as soon as feasible and safe—not merely as soon as the building is open.Play from here
• Arrange backup care, prescriptions, transportation, supplies, staffing, water, equipment, and records. Track time worked for pay and inventory borrowed from or supplied to another clinic.Play from here
• An After-Action Review (AAR) examines what worked, what failed, what was missing, and what should change. Conduct it after the event (the module suggests about two weeks), ask staff what they needed but did not receive and what they would do differently, document the discussion, and present results at the QAPI meeting.Play from here
• Update the clinic emergency plan from the AAR. Even without a disaster, assess and update the plan at least annually.Play from here
• The module’s conclusion emphasizes that preparation cannot prevent every disaster, but it reduces risk and increases confidence in delivering safe dialysis.Play from here

Why answers are correct

• Recovery turns experience into a safer future response. A documented, team-based review catches system failures that individual memory misses.Play from here

Limitations / traps

• An AAR is for improvement, not blame. Do not close the review with only praise or only a list of failures; assign owners and follow-up dates.Play from here

Clinical pearl / safety

• A treatment restart is a controlled return to service: obtain building, water, equipment, staffing, and clinical clearance and communicate the restart plan.Play from here

Exam cue

• After-action findings belong in QAPI and the emergency plan, with annual reassessment even if no disaster occurred.Play from here

Study guide

• The module points readers to CMS emergency-preparedness guidance, CDC water/flood and infection-control guidance, EPA flood cleanup information, FDA medical-device disaster guidance, CISA healthcare/active-shooter planning, Ready.gov disaster and kit information, SAMHSA crisis support, the ESRD Network Coordinating Center, KCER, and National Kidney Foundation emergency resources.Play from here
• Patient-oriented resources include emergency preparation guidance for people on dialysis, a go-bag, emergency meal planning, an emergency kidney diet, phone emergency information, a general emergency kit, and car-safety guidance.Play from here
• Resource links can change. Use the current official site and facility policy rather than relying on an old URL or screenshot.Play from here

Clinical pearl / safety

• Resource lists support—but do not replace—the clinic emergency plan, current medical orders, public-health direction, or emergency services.Play from here

Uncommon words from this chapter. Plain definitions + a short dialysis-related example.Play from here

preparedness

The ongoing cycle of planning, training, exercising, responding, and improving.

Example. Preparedness is a continuous process, not a binder on a shelf.

Play from here

shelter-in-place

Staying inside a protected area when going outside is more dangerous.

Example. Shelter-in-place may be safer than evacuation during some outdoor chemical or weather events.

Play from here

accountability

Knowing where every patient and staff member is.

Example. Accountability at the assembly point is part of life safety.

Play from here

census

The current count and identity of patients in the clinic.

Example. Take the census to the assembly point if it is safe to do so.

Play from here

triage

Sorting people by how urgently they need care when resources are limited.

Example. A triage nurse decides who needs treatment now and who can be rescheduled.

Play from here

continuity

Keeping essential dialysis going, even if the usual site or schedule changes.

Example. Continuity planning includes backup clinics, supplies, and a way to reach patients.

Play from here

cohort

Grouping people with the same infection risk to protect others.

Example. An outbreak plan may cohort symptomatic patients and adjust shifts.

Play from here

contamination

Unsafe material getting into water, dialysate, equipment, or a treatment area.

Example. After fire, flood, or a chemical spill, assume contamination until the system is cleared.

Play from here

potable

Drinkable city water, which is still not automatically dialysis-safe.

Example. The medical director decides whether water is acceptable for dialysis after a disaster.

Play from here

residual

What is left behind, such as leftover disinfectant after a rinse.

Example. Test for residual disinfectant after emergency disinfection before restarting machines.

Play from here

evacuation

Moving people out of the building by assigned routes and priorities.

Example. Never use an elevator for evacuation when fire or power loss makes it unsafe.

Play from here

after-action review

A structured look, after the event, at what worked and what must change.

Example. Take after-action findings to QAPI and update the emergency plan.

Play from here

resilience

The ability of staff and the clinic to recover function after shock or loss.

Example. Staff resilience includes rest, peer support, and help when distress lasts.

Play from here

PTSD

A lasting trauma response that a licensed professional, not a technician, diagnoses.

Example. Do not diagnose PTSD; refer persistent disaster stress to qualified help.

Play from here

psychosocial

Emotional, family, housing, and support needs around an emergency.

Example. Social work helps with psychosocial needs and transport after a disaster.

Play from here

catastrophe

A large event that can cut staffing, roads, utilities, and usual treatment capacity.

Example. A catastrophe may require daily staff briefings and alternate housing or pay methods.

Play from here

structural

Related to the building's walls, floors, and ability to stand safely.

Example. A structural engineer must clear a damaged building before treatments resume.

Play from here

QAPI

Quality Assurance and Performance Improvement: the clinic's formal improvement meeting and process.

Example. Emergency-plan updates belong in QAPI even if no disaster happened that year.

Play from here

escalate

To notify the person or team who can make the next safety decision.

Example. Escalate questionable post-disaster water rather than restarting treatment.

Play from here

disinfect

To reduce germs on a cleaned surface or water path with an approved method.

Example. After a water event, disinfect and rinse the RO, loop, tanks, and machines as directed.

Play from here

• Emergency readiness is a repeated plan–train–exercise–respond–recover–improve cycle.Play from here
• First priorities: personal safety, activate help, protect life, account for patients/staff, then preserve treatment continuity.Play from here
• Triage sorts by urgency; a triage nurse directs priority and rescheduling, while social work helps psychosocial and transport needs.Play from here
• Dialysis patients must be identified to responders and tracked through evacuation, shelter, and backup treatment.Play from here
• Run, hide, fight is the active-threat sequence; call law enforcement when safe and do not re-enter until cleared.Play from here
• Staff should not transport patients in personal vehicles; arrange approved transportation and backup-clinic capacity.Play from here
• CAPD uses gravity and may continue during a power outage; home patients need supplies, food/medication, contacts, and an alternate plan.Play from here
• Never enter a damaged building until cleared; use a buddy system and watch for structural, gas, water, and electrical danger signs.Play from here
• A structural engineer clears the building; biomedical/qualified staff inspect machines and water treatment before restart.Play from here
• Potable water is not automatically dialysis-quality water. The medical director/authorized team decides whether water is safe for dialysis.Play from here
• After compromised water: increase testing/monitoring, compare with baseline, disinfect/flush as directed, check residuals, and verify machines’ conductivity and self-tests.Play from here
• Persistent disaster stress, impaired function, PTSD symptoms, or unsafe coping requires qualified support; staff wellness protects patient safety.Play from here
• Perform an AAR about two weeks after the event, take findings to QAPI, update the plan, and reassess it at least annually.Play from here