We suggest critical care disaster planning include special populations.
Special populations suffered higher morbidity and mortality during recent disasters and have led governmental and nongovernmental organizations to include this group in disaster planning. For example, during Hurricane Katrina, 75% of all deaths occurred among elderly people, who comprised only 15% of the affected population. Forty-four percent of > 600 patients on chronic dialysis missed at least one session, and 17% missed three or more sessions with a concomitant increase in hospitalization postdisaster.
We suggest professional societies, advocacy groups, governmental, and nongovernmental organizations be consulted when planning special population disaster preparedness and just-in-time care.
We suggest daily needs assessment of shelters include identification of those residents from special populations susceptible to decompensation to critical illness. A system to refer those identified to appropriate medical care should be in place.
We suggest disaster preparedness for special populations be part of their primary health-care maintenance. These patients should also be identified pre-event by their community (ie, nursing home facilities, health-care services, and social services providers) as an at-risk group for decompensation during a disaster and measures be taken to ensure they have a continuum of care during the event.
One example of disaster preparedness and care of a specific vulnerable population is the Kidney Community Emergency Response Coalition (KCER), a combined effort of private, professional, and governmental stakeholders. KCER provides disaster preparedness education for patients and dialysis networks as well as for disaster response. Internationally, the Renal Disaster Relief Task Force, an initiative of the International Society of Nephrology, provides just-in-time care and expert resources postevent. A similar model can be adopted for other special needs, such as oxygen therapy, with primary care providers, home health professionals, vendors, and advocacy groups.