University of Texas Southwestern School of Medicine, Dallas, Texas.
Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York.
Kidney360. 2023 Mar 1;4(3):405-408. doi: 10.34067/KID.0000000000000071.
Access to care for patients with ESKD is frequently disrupted after natural disasters, public health crises, and human conflict. Emergency preparation can mitigate the risk of harm and improve outcomes. Before Hurricane Katrina in 2005, the United States was unprepared to assist patients facing disaster. We evaluate responses to Hurricane Katrina which caused unprecedented damage to health and property in the Gulf Coast. As a result of the multitude of identified problems with the national, local, and kidney-specific responses to Katrina, new systems were created that mitigated loss after Hurricane Sandy in 2012. The improved disaster response system was no match for the coronavirus disease 2019 pandemic; real-time changes worsened the effect on highly vulnerable populations, including patients with ESKD. Similarly, preparation can only mitigate the difficulties faced by patients with ESKD living in a war zone. Government agencies need to provide tools and dialysis centers need to educate patients. Beginning with steps implemented in the aftermath of Hurricane Katrina and augmented after Hurricane Sandy, every patient with ESKD and those who care for them must begin emergency preparations before the need arises. Recognizing that it is not possible to prepare for every possible emergency, our health care systems must be ready to adapt to our ever-changing world. After reviewing the responses to previous events, we suggest steps that should be considered to improve preparations for our uncertain future.
在自然灾害、公共卫生危机和人类冲突发生后，终末期肾病（ESKD）患者的医疗服务往往会中断。应急准备可以降低伤害风险并改善预后。在 2005 年卡特里娜飓风之前，美国对如何援助面临灾难的患者毫无准备。我们评估了对卡特里娜飓风的应对措施，这场飓风给墨西哥湾沿岸的健康和财产造成了前所未有的破坏。由于对卡特里娜飓风的国家、地方和肾脏特异性反应存在众多问题，美国建立了新的系统，在 2012 年桑迪飓风来袭时缓解了损失。改进后的灾害应对系统在应对 2019 年冠状病毒病（COVID-19）大流行时无能为力；实时变化使包括终末期肾病患者在内的高危人群受到的影响更加严重。同样，准备工作只能减轻生活在战区的终末期肾病患者所面临的困难。政府机构需要提供工具，透析中心需要对患者进行教育。从卡特里娜飓风之后实施的措施开始，并在桑迪飓风之后进行补充，每一位终末期肾病患者及其照护者都必须在需要之前开始进行紧急准备。我们认识到，不可能为每一种可能的紧急情况做好准备，因此我们的医疗体系必须准备好适应不断变化的世界。在回顾了对以往事件的应对措施后，我们提出了一些应考虑采取的步骤，以改善对不确定未来的准备。
