End-Stage Renal Disease Centers

An End-Stage Renal Disease center is a facility that provides chronic maintenance dialysis to ESRD patients on an outpatient basis, including dialysis services in the patient's place of residence. A certified ESRD facility provides outpatient maintenance dialysis services, home dialysis training and support services, or both. A dialysis center may be independent or hospital-based.

In the State of New Hampshire, End-Stage Renal Dialysis Centers are also required to follow HE-P 811 Administrative Rules.

Getting Started

Before going any farther, make sure your organization has developed a site-specific Hazard Vulnerability Assessment. Use the hazards that make your facility most vulnerable to narrow in on important planning considerations.

The Wisconsin Department of Health Services has created a toolkit for End-Stage Renal Dialysis Centers. If your facility does not already have a plan in place, this would be a good place to start. This toolkit offers an overview of the requirements for ESRDs, as well as some sample templates that can be used in their planning efforts. In topic areas where there was not a tool or template readily available, the toolkit offers planning worksheets that feature a list of example questions to help facilities think through relevant issues that can help them draft their plans and policies.


Emergency Operations Plan

The ESRD facility must develop and maintain an emergency preparedness plan that must be reviewed and updated at least annually. Interpretive guidance for the regulation regarding planning and assessment can be found here.

The plan must do all of the following:

    1. Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach.
    2. Include strategies for addressing emergency events identified by the risk assessment.
    3. Address patient population, including, but not limited to, the type of services the ESRD facility has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans.
    4. Include a process for cooperation and collaboration with local, regional, State, and Federal emergency preparedness officials’ efforts to maintain an integrated response during a disaster or emergency situation, including documentation of the ESRD facility's efforts to contact such officials and, when applicable, its participation in collaborative and cooperative planning efforts.
      • The ESRD facility must contact the local emergency preparedness agency at least annually to confirm that the agency is aware of their needs in the event of an emergency.

Policies and Procedures

The ESRD facility must develop and implement emergency preparedness policies and procedures, based on the risk assessment, emergency plan, and communication plan (below). The policies and procedures must be reviewed and updated at least annually.

ESRDs should cover fire, equipment or power failures, care-related emergencies, water supply interruption, and natural disasters, among others identified in the HVA.

At a minimum, the policies and procedures must address the following:

      1. A system to track the location of on-duty staff and sheltered patients in the ESRD facility's care during and after an emergency. If on-duty staff and sheltered patients are relocated during the emergency, the ESRD facility must document the specific name and location of the receiving facility or other location.
      2. Safe evacuation from the ESRD facility, which includes staff responsibilities and needs of the patients.
      3. A means to shelter in place for patients, staff, and volunteers who remain in the facility.
      4. A system of medical documentation that preserves patient information, protects confidentiality of patient information, and secures and maintains the availability of records.
      5. The use of volunteers in an emergency or other staffing strategies, including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency.
      6. The development of arrangements with other ESRD facilities or other providers to receive patients in the event of limitation or cessation of operations to maintain the continuity of services to ESRD facility patients.
      7. The role of the ESRD facility under a waiver declared by the Secretary, in accordance with section 1135 of the Act, in the provision of care and treatment at an alternate care site identified by emergency management officials.
      8. How emergency medical system assistance can be obtained when needed.
      9. A process by which the staff can confirm that emergency equipment, including, but not limited to, oxygen, airways, suction, defibrillator or automated external defibrillator, artificial resuscitator, and emergency drugs, are on the premises at all times and immediately available.

Communications Planning

ESRDs must also develop and maintain an emergency preparedness communication plan that complies with Federal, State, and local laws and must be reviewed and updated at least annually. The communication plan must include all of the following:

    1. Names and contact information for staff; entities providing services under arrangement; patients’ physicians; other ESRD facilities; and volunteers.
    2. Contact information for federal, state, tribal, regional, and local emergency preparedness staff, and other sources of assistance.
    3. Primary and alternate means of communicating with ESRD facility's staff, and federal, state, regional, and local emergency management agencies.
    4. A method for sharing information and medical documentation for patients under the ESRD facility's care with other health care providers to maintain the continuity of care.
    5. A means to release patient information in the event of an evacuation
    6. A means of providing information about the general condition and location of patients under the facility’s care
    7. A means of providing information about the ESRD facility's needs, and its ability to provide assistance, to the authority having jurisdiction or the Incident Command Center

Training and Testing

There are two sections that apply to the Training and Testing component of the Emergency Preparedness Program. One section covers internal training, and the other external or community exercises and drills.


Staff Training

Annually, all ESRDs must provide training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, and volunteers. The training must:

    • Demonstrate staff knowledge of emergency procedures, including informing patients of: what to do, where to go (including off-site relocation areas), whom to contact if the emergency occurs when the patient is not at the facility (including alternate emergency phone numbers for the facility), and how to disconnect themselves from the dialysis machine if an emergency occurs.
    • Maintain CPR certification
    • Properly train nursing staff in the use of emergency equipment and emergency drugs

All documentation regarding these requirements must be maintained and accessible.

Patient Orientation

ESRDs are required to provide an appropriate orientation and training to patients, specifically with regard to the emergency procedures outlined above in Staff Training (emergency numbers, disconnection, evacuation sites, etc.).


The facility is required to conduct testing of the emergency plan at least twice, annually. An analysis of the emergency plan should be conducted after all exercises and events and must be documented.

One of the exercises can be a functional exercise that is community-based (involves more than just the facility), or an individual, facility-based exercise if a community-based exercise opportunity is not available. If the facility experiences an actual emergency that requires the activation of the emergency plan, the facility is exempt from engaging in a community-based or facility-based functional exercise for one year following the event.

The second exercise could include a second functional exercise that is community-based or facility based. However, it can also be a tabletop exercise that includes group discussion led by a facilitator using a narrated, clinically-relevant emergency scenario, a set of problem statements, direct messages, or prepared questions that are designed to challenge an emergency plan.