19.3 Fire, Threats and Power or Water Interruptions

A Plan That Can Be Used

Dialysis patients may be connected to an extracorporeal circuit when fire, violence, a threat or utility failure occurs. Emergency planning must therefore include more than a generic evacuation sign. Staff need assigned roles, knowledge of safe machine termination, patient mobility needs, emergency contacts and alternate treatment arrangements. The plan is practiced and revised from drills and actual events.

Identify who leads the response, calls emergency services, manages machines, assists patients, brings essential records and accounts for everyone. Backup leadership is necessary when the usual manager is absent. Plans must cover people with limited mobility, language needs or cognitive impairment. A written document kept where staff cannot quickly reach it is not sufficient operational readiness.

Fire and Evacuation

When fire or smoke is discovered, activate the facility alarm and emergency response, protect those in immediate danger and follow the evacuation procedure. Close doors and limit exposure when safe. Only trained staff use extinguishers for a suitable small fire under the plan; they must not delay evacuation or enter an unsafe smoke-filled area. The local procedure defines priorities and routes.

Dialysis circuits require the approved emergency disconnection or termination technique. Device capabilities and the immediate danger determine whether blood return is safe and feasible. Do not insist on completing a normal rinseback while smoke threatens life. Do not improvise cutting or connecting lines outside the trained emergency process. Staff need practice with the actual equipment and emergency supplies before the event.

Bomb Threats and Security Events

For a threat received by telephone or another channel, follow the security plan: record the information that can safely be obtained, notify designated leadership and authorities, and act on their directions. Do not touch or move a suspicious object. Searches, evacuation timing and communications are managed through the trained emergency process rather than by individual speculation.

Violence or an immediate security threat may require sheltering, evacuation or another protective action appropriate to the situation. Protect patients without placing staff into avoidable danger. The plan should address how to summon help and communicate quietly or quickly when ordinary systems are unavailable. Preserve relevant information for responders without spreading unverified claims across the unit.

Power Interruption

A machine's battery may support only some functions or a limited period. It does not necessarily permit continued full treatment. Manual pump operation and blood return vary by model; a universal hand-crank instruction is unsafe. Stop and secure the circuit as trained, assess the patient and coordinate termination. Do not restart all machines simply because lights return; verify system readiness and prescription status.

Water Loss or Contamination

Water failure can include low supply pressure, chemical contamination, municipal disruption or treatment-system malfunction. Stop unsafe exposure and notify technical and clinical leadership. Conduct the required water tests and determine whether a validated compliant alternative exists. A municipal boil-water notice does not automatically translate into a dialysis-water procedure; dialysis safety depends on the full treatment system and applicable guidance.

Do not connect patients to untreated water, bypass a failed carbon bed or rely on RO conductivity alone to exclude chlorine, bacteria or endotoxin. After repair or disinfection, confirm the relevant chemical, microbial and residual requirements before resuming according to the responsible team's process. Preserve logs and sample information so the cause can be investigated.

Continuity of Care

A disaster may require alternate facilities, patient transport and adjusted scheduling. Maintain accessible patient identification, prescription, medication, allergy and access information through the approved plan. Protect privacy while ensuring receiving clinicians have needed facts. Coordinate with the ESRD network and emergency partners as applicable. A list of alternate sites is useful only if the communication process can determine availability.

Teach patients how to contact the facility after disruption and what to do if treatment is delayed. Any emergency diet or fluid instructions are individualized and should not be interpreted as a substitute for dialysis indefinitely. Patients need to know which symptoms require emergency help. Home patients require their own device-specific utility and backup plan.

Drills and Recovery

Practice realistic scenarios including a treatment in progress, a mobility-limited patient and failure of an ordinary communication channel. Record delays, missing equipment and conflicting instructions. Revise the plan and retrain; simply documenting attendance does not establish readiness. After an actual event, account for patients and staff, arrange ongoing care and evaluate exposures or injuries.

Scenario

A unit loses power while patients are connected. Staff implement the machine-specific safe-stop and return procedure, assess patients and communicate through the backup plan. One machine's battery preserves displays but not full treatment operation. Recognizing that limitation prevents unsafe assumptions. Once power returns, qualified personnel check the system and water readiness before treatment is restarted. The objective is safe continuity, not finishing every scheduled minute at any cost.

Sources: CMS emergency preparedness, §494.62, CDC dialysis water safety.