Another example of successful coordination and collaboration was provided by Dr. McKnight, a Baton Rouge nephrologist:

"We always, as soon as hurricane season starts, have two weeks of supplies on hand for every single patient. Normally we have about a week’s worth, but we always get at least two weeks’ worth, so we had extra supplies on hand. Then I called the Office of Emergency Preparedness (OEP) and told them who I was and what our dialysis plan and needs were. I gave them my cell phone number to call me and we routinely checked in. When OEP heard from Network 13 that potentially 5000 patients were coming into this area, OEP called me and said, "We need to set up a dialysis facility at the PMAC." Dialysis facilities take nurses, machines, water treatment systems, tons of equipment. . . So we called a Baptist Church who had a 15-passenger handicap van that they were not using. The dialysis clinic manager’s husband, after getting approval from our company, drove the van so we could put patients in wheelchairs in the van. It was large enough to put family members with them so we weren’t separating family members. We had, depending upon the time, either a nurse, a social worker, or a physician ride in the van, because we were transporting patients from the PMAC. So in case there was any emergency on the bus, we had somebody there. We also had a physician at the dialysis clinic, so that when patients came, if there was a problem, there was somebody sitting here who could handle the problems…"

"I called my office nurse and told her to come down to the PMAC. Every time any bus, ambulance, van came in with a new group of people to the PMAC, she would say, "Are you a dialysis patient?" So instead of letting patients get in, get put on a cot and get stuck somewhere, she would identify them. She got some wristbands and tied it around their wrist to identify them as a dialysis patient and she would give them numbers one, two, three or four, depending on when their last dialysis treatment was. That way, when the van came around to drop a group of patients off and pick up another group, we were able to triage which ones needed to go right now and which ones needed to go later. . ."

"I spent time at the PMAC intermittently. The first day I probably spent about 20 hours there. Because it was not something that was thought of, the dialysis patients, prior to the hurricane, there was not any central person to coordinate [this group]. So, my phone number got written – my cell phone number got written up on the board, and I had family members from all over the country with missing patients calling me at all hours of the day or night, wanting to know where their family member was, and if I had seen them. Although we dialyzed in the first 48 to 72 hours a significant proportion, after about 48 hours, the other facilities geared up and started dialyzing, so I didn’t know where patient was. We also did peritoneal dialysis which is a dialysis that patients normally do themselves at home. There was a room in the PMAC that was set aside to do that and so solutions and equipment were delivered there. Unfortunately, the only room that we had was the death and dying room, so we had hospice patients on one side and dialysis patients on the other side. I think that there was good coordination, once I met the NIH public health doctor, a nephrologist, who was there. When he found out I was a nephrologist, we talked on a regular basis. Eventually, the emergency medicine program from Baton Rouge General and Earl K. Long took over and started running the PMAC, which worked really well, because they were used to how you get things done in Baton Rouge. They were used to the organization, used to the triage system and that worked very well. . . "

"We coordinated with the other group of nephrologists in town to have a nephrologist at the Baton Rouge General and at The Lady of the Lake so that, if we had a patient who was in one of those hospitals and we couldn’t get there for traffic reasons, there was a doctor there to take care of them. We tried to get everybody out into an outpatient dialysis facility and not to the hospital, because we didn’t want to clog up the hospital with a lot of dialysis patients. It could have just shut down the whole system, [so moving dialysis patients] was a good thing. . ."

"Do I think [the situation] would be better today? Yes, because we all met and we all know each other. The head of the other group of nephrologists and I have agreed that, if a disaster comes again, we’ll take shifts at being at the OEP so one of us is physically on hand for them to ask questions to and know what to do. . ."

"We then had a very forward-thinking doctor, Dr. Paul Miller, out of the Opelousas area, who organized some school buses and Greyhound buses. They came over to the shelter and picked up 50 patients a day and trucked them out, which worked very well . . . A lot of people got nervous about that, but it worked very well. If we had the same number of dialysis patients after a week that we had the first week, our system would have been very stretched; but because we dropped it down to about half of what we did the first week, we were able to handle it. "