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Climate change disasters require plans for dialysis patients, experts say

When flooding hit B.C. in 2021, patients had to be flown by helicopter to receive regular treatment
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Mitchell Dyck, de Chilliwack, en Colombie-Britannique, que l害羞草研究所檕n voit sur cette photo, faisait partie des patients qui n害羞草研究所檕nt pas pu se rendre 脿 l害羞草研究所檋么pital pour une dialyse vitale lors des inondations de 2021 qui ont emport茅 les autoroutes et ont incit茅 les professionnels de la sant茅 脿 r茅fl茅chir 脿 la meilleure fa莽on de coordonner les soins vitaux lors de catastrophes li茅es au changement climatique. LA PRESSE CANADIENNE/Photo fournie

When catastrophic floods severed a bridge and washed away or closed highways in southern British Columbia, Mitchell Dyck and other patients needing regular life-saving dialysis had to be flown to hospital by helicopter.

The flooding caused by record-breaking rain in November 2021 shut down every route to the rest of Canada and made it impossible for Dyck to make the 25-minute drive from his home in Chilliwack to the dialysis unit of the Abbotsford Regional Hospital.

Dyck, now 25, was receiving overnight dialysis three times a week because his kidneys did not filter waste and excess fluids from his blood due to a genetic disease diagnosed a year earlier. He said a nurse called him and others to say they should head to the Chilliwack airport to board a helicopter, but the anxious patients encountered 害羞草研究所渃haos害羞草研究所 there and he arrived at the hospital just in time for his treatment.

害羞草研究所淚t was a little bit concerning, and my family was definitely concerned too with whether I was going to be able to get there,害羞草研究所 Dyck said of the scramble for treatment during a climate disaster that forced nearly 15,000 residents in several communities out of their homes and killed five people in a landslide.

While some dialysis patients were put up in hotels, Dyck stayed with his grandparents in Abbotsford until portions of Highway 1 were open to traffic two weeks later. After receiving dialysis for nearly two years, Dyck had a kidney transplant in August 2022 and now takes eight medications, including immunosuppressants and drugs for high blood pressure that he always stocks in case of an emergency.

A 2022 Environment Canada study suggested that climate change made the B.C. floods at least twice as likely and it害羞草研究所檚 possible that similar events will increase as greenhouse gases keep entering the atmosphere.

The likelihood of more disasters, including wildfires and droughts, has nephrologists calling for better emergency planning across the country to ensure that uniquely vulnerable dialysis patients have access to treatment without which kidney failure could cause life-threatening conditions or death.

Dr. Shaifali Sandal, a transplant nephrologist at the McGill University Health Centre in Montreal, is working on a project with the Canadian Society of Nephrology to determine how best to manage kidney patients during disasters.

She said Montreal General Hospital cared for at least 20 extra dialysis patients last summer after Cree Nation communities in northern Quebec were evacuated due to wildfires.

害羞草研究所淥ur units are already over capacity and we actually requested the help of neighbouring units that are not affiliated with us,害羞草研究所 Sandal said.

As part of the project funded by the Canadian Institutes of Health Research, she will be setting up a task force to get feedback from health professionals and patients across the country to understand how care can be better co-ordinated during emergencies.

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Sandal is also reviewing research papers on the lessons learned in other countries about caring for kidney patients during various emergencies.

害羞草研究所淲e want to apply experiences from disasters including an earthquake that displaced people in Japan and experiences in Ukraine due to war and climate-change emergencies that forced people out of their communities,害羞草研究所 Sandal said.

害羞草研究所淭hey害羞草研究所檙e saying, 害羞草研究所楬ave a contingency plan, have a communication plan, have a network within your region, so that if you have to accommodate extra patients, you can do it. Have a disaster co-ordinator in each region.害羞草研究所櫤π卟菅芯克鶟

Sandal said BC Renal, a network in British Columbia that plans and co-ordinates care of patients with kidney diseases, could serve as a model for the rest of Canada because it offers 害羞草研究所渁mazing害羞草研究所 resources to help patients prepare for an emergency.

害羞草研究所淚 think we just need BC Renal害羞草研究所檚 permission to share them with every other centre and translate them into different languages,害羞草研究所 she said.

Sarah Thomas, a registered nurse and emergency management lead at BC Renal, said the network is unique because it works with the province害羞草研究所檚 five regional health authorities in planning for emergencies so dialysis patients can be sent out of their home community if an evacuation order has been issued.

害羞草研究所淭hat might mean every health authority is looking at their capacity to take patients,害羞草研究所 Thomas said. 害羞草研究所淲e offer that support to the health authorities, which are busy taking care of patients.害羞草研究所

BC Renal recently created an emergency team of 12 hospital-based dialysis nurses who can be deployed to one of the province害羞草研究所檚 29 community clinics or another hospital offering the treatment rather than airlifting patients 害羞草研究所 unless the area has been evacuated, Thomas said.

Each nurse on the team educates patients to start their renal diet during an emergency by limiting fluids and eating low-potassium food, which includes berries, cauliflower and broccoli. Patients must also take a prescribed powder that can be mixed with water to lower blood potassium levels for the short term until treatment is available.

BC Renal will also be developing a policy on how to accommodate dialysis patients when water restrictions are in place during a drought or if a water main breaks in a hospital. Each dialysis session uses up to 500 litres of water, three times a week per patient, as part of the procedure that is also dependent on electric power.

害羞草研究所淚n the worst case we probably have to relocate (patients) to another area,害羞草研究所 Thomas said.

害羞草研究所淚 know people think (intensive care units) are life support. But dialysis is also life support,害羞草研究所 she said. 害羞草研究所淲e had to come up with something to ensure that we had agile emergency procedures in place because if our patients don害羞草研究所檛 get the treatment they will get sick, end up in hospital and could die.害羞草研究所

Health information about all kidney patients, whether they get dialysis or have received a transplant, is stored on an electronic registry that is available anywhere in B.C., unlike other patient records, Thomas said.

害羞草研究所淚t害羞草研究所檚 unique to B.C. We害羞草研究所檝e created this. The rest of Canada is saying, 害羞草研究所榃hat害羞草研究所檚 BC Renal doing?害羞草研究所櫤π卟菅芯克鶟 she said of interest in the emergency preparedness program.

Thomas said the network害羞草研究所檚 bolstered emergency response plans began during the COVID-19 pandemic and a trio of climate-change calamities that hit British Columbia in 2021 害羞草研究所 record-setting wildfires, including one that nearly destroyed the town of Lytton, an unprecedented heat dome that led to 619 deaths in the province, and an atmospheric river that caused flooding in the Abbotsford area.

害羞草研究所淲e know that more and more climate emergencies are going to happen, and we are going to be better prepared to make sure patients have the care that they need.害羞草研究所

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

-Camille Bains, The Canadian Press

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