Protecting the Most Vulnerable: Multilevel Response Model for Hemodialysis During Natural Disasters

Background: Patients on chronic hemodialysis (HD) are highly vulnerable during natural disasters due to their strict dependence on regular treatment. In October 2024, a DANA storm caused severe flooding in the Valencian Community (Spain), severely affecting extra-hospital HD centers. This report describes the organized response that ensured continuity of care for over 1,700 patients. Methods: Retrospective descriptive analysis of the emergency response implemented in Diaverum Spain centers in Valencia during the 2024 DANA. The intervention was based on ten pillars of the Contingency Plan: (1) Crisis Committee activation; (2) Multilevel communication plaN; (3) Access to patient data; (4) Advanced contingency preparation; (5) Supply chain maintenance; (6) Reinforcement of staff; (7) Help points; (8) Medicine bank; (9) Psychological support; and (10) Social assistance. A specific protocol for “Preventive and Complementary Care in Floods” was also activated, including education, triage, and clinical management. Results: Of 13 HD centers in Valencia, 3 became inoperative. Within 24 hours, 98% of the 280 affected patients were relocated and treated. Total service coverage reached 99% for 1,770 patients. Emergency transport routes were enabled via taxis, UME, Civil Guard, and firefighters. Staff and communication were reinforced across provinces. Internal clinical protocols were activated. Only one death was reported, not directly linked to dialysis interruption. Conclusion: This case demonstrates that integrating HD into disaster preparedness plans is feasible and effective. Key factors included early planning, logistical agility, and coordination between professionals and authorities. The model represents a replicable best practice for protecting chronic patients in crisis scenarios and highlights that continuity of care in emergencies is a core element of safety and quality.