style="font-size:15px;"> Dialysis schedule – Knowing what days of the week the patient has dialysis, as well as the day of the most recent session is useful.
Length of sessions – Attempt to determine how many hours each dialysis session is, as well as if the patient is completing the full length each time, with attention to the last session. If transporting from the dialysis center, it is important to determine whether the session was completed, partial, or not even started.
Volume status – Each patients should have a known “dry weight,” which is the ideal euvolemic weight. Additionally, knowing the patient’s current weight can greatly help with fluid status assessment. The patient or dialysis center staff may also be able to state how much weight/fluid is removed with each dialysis and/or the current net fluid volume.
Vital signs – Dialysis patients may have “abnormal” vital signs at baseline. If so, careful documentation of the patient’s baseline heart rate and blood pressure is important. Refrain from using the limb on the same side of hemodialysis access to prevent complications like thrombosis.
Urine output status – Whether or not an ESRD patient is still able to make urine for diuresis is often helpful in treatment decisions of the fluid overloaded patient.
Destination selection
Should a patient with ESRD require transport, it may be necessary to choose a destination hospital that can care for his or her needs. Even if the patient is not presenting to EMS for a dialysis‐related complaint, should he or she require admission, renal replacement therapy will be required, eventually. The greater risk of coronary artery disease and stroke may necessitate specialty care more often than in the otherwise healthy nondialysis patient. Local protocols may be developed to address this specific patient population and its particular needs.
Resource planning
The individual in the community who is dialysis dependent requires unique resources for his or her survival. While under normal conditions the patient likely has established mechanisms for obtaining transportation and treatment, this system can be disrupted in the case of a disaster or disruptive weather event. The local emergency management agency should work alongside EMS medical directors and the dialysis providers to develop contingency plans appropriate for the local environment. Large dialysis center networks may operate a central command/tracking system that can be a resource for planning and disaster management. Other government and local agencies will need to contribute to this planning process, as operation of a hemodialysis machine requires infrastructure that is easily disrupted. Identification and registry of the patients who will require emergent dialysis services in times of need can allow for continued access to life‐sustaining care.
Convalescent Transportation
Hemodialysis patients have a frequent need for transportation to a medical facility for regular treatment sessions. Patients may require assistance in this regard, relying on nonemergency transportation services. There exists a wide variety in the training level of personnel handling this form of transportation. People in this field may become well acquainted with their “regular” dialysis patients and be able to recognize subtle changes in their condition, which may require diversion to a higher level of care. Protocols should be established to assist in the recognition of emergencies in this high‐risk population. If the particular transport unit does not possess the capabilities to care for emergency medical conditions, personnel should know the best method of accessing the resources required to do so.
References
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