Disaster preparedness for earthquakes in hemodialysis units in Gyeongju and Pohang, South Korea

Yoo, Kyung Don; Kim, Hyo Jin; Kim, Yunmi; Park, Jae Yoon; Shin, Sung Joon; Han, Seung Hyeok; Kim, Dong Ki; Lim, Chun Soo; Kim, Yon Su

When an earthquake occurs, a power failure is likely to follow. A large-scale blackout can have diverse effects on hemodialysis patients [32] . A thunderstorm in the Midwest of the United States in 2012 caused a power outage in 30% of the area's dialysis facilities. Even if a backup generator is present, it may be difficult to use. New Jersey and Maine of the United States have laws enforcing installation of backup generators [32] . Currently, there are no regulations about installing backup generators in hemodialysis units in South Korea. Dialysis staff need to know the capacity of their hemodialysis center and be aware of how much power reserve they have (Supplementary Table 1 ; available online). Moreover, dialysis staff should be familiar with emergency power supply contacts ( Table 2 ). Different dialysis machines may activate different functions in case of power failure. Display monitors, blood pump, arterial and venous pressure alarms, and air bubble detector functions often work during a power outage while hemodiafiltration and transmembrane pressure (TMP) alarms do not work. When the power is off, the water supply system is shut down and the TMP and conductivity menu operation may not operate. A backup power supply to the battery should be built into the machine to continue treatment for a limited time. Extracorporeal blood circulation reinfusion into the patient should be performed if the power outage continues for more than 15 minutes. Dialysis does not proceed because there is no influx of dialysate during a power outage. When power is applied to each center, dialysis staff should verify that the dialysis time is extended by the amount of inactivity and that all dialysis machines can supply backup power to the battery in case of an emergency. [20, 21] Dialysis staff should be familiar with the dialysis machine's manual blood pump reinfusion process when a power failure occurs during dialysis. Dialysis staff and patients may need a blood circulator that can manually operate the blood circulation pump to prevent blood clotting if the hemodialysis machine is powered off. The following procedure should be considered: 1) release the air sensor (pull the vein tubing line out of the air sensor lock); 2) place the manual blood circulator in the blood circulation pump; 3) make sure all locks are open; 4) make sure the manual blood circulator is turned in the direction of blood flow; 5) turn slowly at a constant speed; 6) check that there are no air bubbles in the blood line; 7) if possible, calculate how long the power supply has stopped; and finally 8) manually circulate the blood circulation pump for up to 10 minutes. If more than 10 minutes pass, terminate hemodialysis.