When extreme flooding swept the Fraser Valley and Interior of BC in November 2021 – washing out roads and resulting in a provincial state of emergency – many kidney patients in the Fraser Valley had to evacuate to continue receiving life-saving dialysis. For renal programs already grappling with staffing shortages and the long-term effects of the COVID-19 pandemic, the floods were yet another blow. They also proved to be a catalyst for change, leading to the creation of the provincial Hemodialysis Emergency Response Team (or HEST).
“The various climate-based disasters we’ve weathered over the past few years are not anomalies,” explains Sarah Thomas, BC Renal project manager and HEST lead. “Climate emergencies will continue to impact dialysis care. We can’t stop them from happening, but we can optimize how we respond – in particular, ensuring that rural and remote areas are not disadvantaged, and that patients are kept as close to home as possible in crisis situations.”
Sarah describes the program, which officially launched earlier this year, as “a pivotal strategy in agile emergency response that simultaneously addresses a need for enhanced support and mentorship of new nurses during non-emergent times.” The program includes funding for 12 new positions, with nurses hired by their respective health authorities, and features a dual reporting relationship to BC Renal. Ongoing leadership for emergency management training and operations will be managed by BC Renal, while the health authorities will oversee the day-to-day components of the role.
An experienced renal nurse herself, Sarah explains that the program overcame historical barriers to moving specialized nurses across regions and clinics, and ensures HEST nurses are trained on multiple dialysis machines. “With HEST, a team of hemodialysis nurses is prepared to work in any dialysis unit across the province on short notice. Depending on the severity of an emergency, the nurses can be dispatched as a team or in smaller groups.”
She goes on to explain that when the nurses are not actively dealing with an emergency, they work as mentors in their own programs: orienting new hires to the unit, creating learning strategies, and acting as a liaison between current staff and new hires. “Retainment of new nurses is crucial,” Thomas says. “Beginning a career in complex specialty care can pose a number of challenges, but with the additional support of the HEST nurses, we hope to ease this transition and ensure new hires feel prepared.”
In late January the HEST nurses gathered together for the first time in Vancouver to get to know each other and the program. We spoke to several of them about their experiences in renal care and thoughts on the program’s impact.
Asked about their interest in the HEST role, a few nurses cited previous experiences with emergency management – they wanted to put their knowledge to use on a provincial scale. “While working, I’ve had to deal with and plan around several emergencies, including water shutdowns and extreme staff shortages,” says Dino Angelucci, the HEST nurse at Vancouver General Hospital. “My experiences prepared me for the HEST role, and also showed me the gaps in information on what to do during an emergency.”
Ruby De Lasan-Galvan – who moved to Interior Health in 2022 after working as a dialysis nurse in Manitoba for nearly a decade – explains, “Manitoba is famous for its frigid winter and heavy snowstorms. It has always been a challenge to ensure that dialysis patients will continue to receive life-saving treatment in these conditions. Knowing I could utilize my knowledge from those experiences contributed to my confidence with HEST.”
Naomi Martens, a nurse at the Abbotsford Regional Hospital, was involved in the response to the Fraser Valley flooding – the emergency that triggered HEST’s development. “I was working in peritoneal dialysis at the time, and we had patients who could not come to the PD unit due to road closures. After back roads were opened to essential travel, I relocated to Chilliwack from my home in Abbotsford for a week – transferring supplies, training a couple of patients in their homes, and visiting others who had outstanding issues.” When asked what this experience taught her, Naomi says, “Flexibility, teamwork and an open mind are needed to provide the best care we can to patients in extenuating circumstances. In extraordinary circumstances, we can come up with extraordinary solutions.”
The HEST nurses are optimistic about the solutions their program will offer. Laura Dicer, who works in renal services in Interior Health, is looking forward to a more direct, focused approach to emergency planning. “The longer I spend with HEST, the more I think of different emergency scenarios and how we can better prepare for them,” she says. “Having a team approach to emergency planning is essential – when an event does occur we will jump in to help each other as required.” Naomi echoes this sentiment: “People with renal failure already face so many uncertainties. When an extreme situation arises, I hope the HEST nurses can provide a sense of reassurance for patients, while also ensuring that medical staff have the necessary back-up to continue providing patient care.”
When it comes to the role’s mentorship component, Ruby says she’s looking forward to seeing young nurses gain confidence and pass along a healthy culture in the nursing environment. “I am also excited to find out what I might learn from our future mentees – learning goes both ways.”
Despite the physical distance between nurses, the team is already feeling connected – thanks, in large part, to the strength of their leadership. “Seeing how passionate everyone is about this role made me envision its success – on a provincial and national level,” says Ruby. “With a great leader like Sarah, I have confidence in the plans and goals of this team.”
As health care authorities across the country grapple with the ‘new normal,’ interest in innovative methods of emergency response has grown. Since its launch, HEST has fielded inquiries from other PHSA programs, and even garnered attention from the Ontario health system. “Given our current climate, there’s a growing need in health care for proactive approaches to emergencies – not just reactive ones,” Sarah says. “HEST has the potential to set the curve, inspiring similar teams nation-wide.” In Dino’s words, “I think that HEST is a forerunner, and that’s why other provinces are taking interest – they can learn from us and we can assist them to build their own role. Ultimately, our goal is to improve emergency planning across the country, leading to the best possible care for patients.”
