Preparing for

Emergencies:

A Guide for

People on Dialysis

Photos courtesy of NOAA Photo Library
IMPORTANT: This booklet has helpful information for

people on dialysis. However, you should always ask your

doctor for medical advice. The tips in the booklet may NOT

work for every patient or in every emergency situation. You

may have special health problems or conditions that will

need to be handled differently. Talk to your doctor and renal

dietitian to discuss which of the tips in this booklet can

work for you, and which tips you should adjust. 

If you need immediate medical attention at any time, try to

contact your doctor, or dial 911 (where available).
Preparing for Emergencies:

A Guide for People on Dialysis

The Centers for Medicare & Medicaid Services
The Centers for Medicare & Medicaid Services gratefully acknowledges

the Trans Pacific Renal Network and its executive director, Arlene

Sukolsky, who contributed to the development of this guide. Grateful

thanks to the following colleagues who also contributed:

Ann Albano, RN, CNN

Herbert Davis

Sandy Gustafson, RD

Ann Holmes-Heintz, RN

Brian O’Moore

Kent & Patty Stewart

Joan Van Wagner, BA, RN

Helping you help yourself.

2
Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Helpful Tips in an Emergency and Travel Tips . . . . . 5

Steps to Prepare for an Emergency . . . . . . . . . . . . . . . 7

Gather and Carry Important Medical Information . . . . . . 7

Make Alternative Arrangements for Treatment . . . . . . . . 14

Prepare an Emergency Stock of Supplies,

Medicines/Medical Supplies, and Food . . . . . . . . . . . . . . . 17

Know What Diet to Follow if Your Dialysis

Must be Delayed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

How to Disinfect Water . . . . . . . . . . . . . . . . . . . . . . . . 28

If You are on a Dialysis Machine

in an Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

For More Information . . . . . . . . . . . . . . . . . . . . . . . . . 32

3
Introduction

Emergencies caused by severe weather or disasters can

happen with or without warning. If you need dialysis,

having power and water, transportation, or supplies may be

very important. Some emergency situations may make it

impossible for you to get to your dialysis facility or give

yourself dialysis. It is important to be prepared so you can

feel better and stay healthier.

This booklet explains:

■ Helpful tips.

■ How to prepare for an emergency.

■ How to disinfect water.

■ Helpful contacts for more information.

Preparing for Emergencies has important information to

help keep you healthy.

4
Helpful Tips in an Emergency

1. Stay at home unless you are hurt, as long as it is safe to

do so. Instructions for dialysis patients may be available

on TV, radio, or by phone or messenger. Depending on

the nature of the emergency, you might want to call your

dialysis facility or doctor, because he or she might be able

to help you manage this emergency.

2. Take a fanny pack or backpack stocked with emergency

supplies, food, and medication with you if you will be

away from home when severe weather or a natural

disaster is predicted. 

3. Make sure your dialysis facility knows where to find you.

4. Start your emergency diet (see page 22) as soon as an

emergency situation is predicted or occurs, if it

could delay your next regular dialysis treatment.

5. If you must go to a shelter, tell the person in charge

about your special health needs. 

6. If you need medical treatment, make sure your dialysis

access is not used for anything other than your dialysis

treatment. No one should use your access to give you

fluid or medication. 

7. Follow the instructions in this booklet to be prepared.

5
Remember: Hospitals may not be able to give you 

maintenance dialysis treatments.

Travel Tips

1. Make arrangements for dialysis at your destination, or

have necessary equipment or supplies delivered ahead

of time.

2. Carry an extra 2-3 day supply of all your medicines/

supplies in your hand-carried luggage and keep it with

you at all times. A fanny pack or backpack may be more

convenient. If your luggage is lost or misplaced, you will

still be able to take your medicine until it is found or you

can get another supply. 

6
Steps to Prepare for an Emergency

1. Gather and carry important medical information.

2. Ask your facility about how to find out about alternative

arrangements for treatment.

3. Prepare an emergency stock of supplies, food, and

medicines.

4. Know what diet to follow if your dialysis must be delayed.

Step 1

Gather and Carry Important Medical Information

If you must go to a different dialysis center or hospital for

treatment during an emergency or travel, or if you need

emergency health care, the medical staff need to know your

medical status so you can get the right treatment. When

your kidneys don’t work, your body processes medicines

differently. You must also reduce your fluid intake. Keeping

medical staff aware of your medical status helps protect you

from getting treatment that could be harmful to you. Keep

your medical information with you at all times. You may

also want to give a copy to a caregiver or family member.

To help you keep this important information handy, a

medical history form is printed on the next few pages. Fill it

out and keep it with you at all times. 

7
Medical History

Print this information clearly and update it regularly.

Date updated:___________________________________________

Personal Information

Name:__________________________________________________

Last First MI

Address:________________________________________________

City:________________________ State:________ Zip:__________

Home Phone ( ) ______________________________________ 

Emergency Contact: _____________________________________

Name

Relationship to you: _____________________________________

Address:________________________________________________

City:________________________ State:________ Zip:__________

Phone: ( ) ___________________________________________

8
Insurance Information

Medicare Number: ______________________________________

(From your red, white, and blue Medicare card)

Other Insurance: ________________________________________

________________________________________________________

________________________________________________________

Medical Information

Primary ESRD diagnosis: ________________________________

Other medical conditions: ________________________________

________________________________________________________

Allergies or complications:________________________________

________________________________________________________

________________________________________________________

Other (previous operations, illnesses):_____________________

________________________________________________________

Your usual dialysis treatment (check one):

____ Center hemodialysis

____ Home hemodialysis

____ Chronic ambulatory peritoneal dialysis (CAPD)

____ Chronic cycling peritoneal dialysis (CCPD)

____ Intermittent peritoneal dialysis (IPD)

9
Your dialysis center: _____________________________________

(Name of center)

Address: ________________________________________________

City:________________________State:_________Zip:__________

Phone: ( ) ______________________________________________

Your doctors:____________________________________________

________________________________________________________

Other emergency phone numbers:

________________________________________________________

________________________________________________________

________________________________________________________

Local utilities:___________________________________________

________________________________________________________

________________________________________________________

10
Current Medications

You need to carry information about all the medicines you

take. List those prescribed by your doctor and any over-thecounter medicines you may take.

Name of Medication Dosage Frequency

(Like 50 mg) (Like twice a day)

11
Medical Emblem

If you are injured or unable to communicate, medical staff

need to know quickly if you are a person on dialysis and any

other important facts about your health. One way to alert

people to your health needs is to wear a medical emblem on

a bracelet or necklace. It shows an internationally

recognized symbol that lets people know your medical

diagnosis, such as “Diabetes.” It also provides a phone

number medical staff can call to get more detailed medical

information about you. Wearing a medical emblem at all

times helps ensure that you get the care you need, and that

you don’t get care that could be harmful to someone with

your medical condition. Also carry the medical information

card that comes with the emblem. It has important

information and may reduce the need for phone calls to the

emblem registry service.

NOTE: A necklace might be missed if your upper body

clothes are rolled up. A bracelet is easy to see, but it

shouldn’t be worn on the same side as your dialysis access.

It could block blood flow if it is pulled up the arm.

To get a medical emblem:

Ask your nurse or social worker for information about

medical emblems. They can give you information about the

National Kidney Foundation (1-800-488-2277) or the

American Kidney Fund (1-800-638-8299). In some areas,

these organizations cover the cost of your first emblem. 

12
Other sources of medical emblems include:

■ MedicAlert Foundation, 2323 Colorado Avenue, Turlock, 

CA 95382, or call 1-800-ID-ALERT (1-800-432-5378).

■ Body Guard, 111 East Parkway Drive, Egg Harbor 

Township, NH 08234, or call (1-609-646-4777).

■ Your local pharmacy.

13
Step 2 

Make Alternative Arrangements For Your Treatment

If you get in-center hemodialysis:

■ Make sure your dialysis center has your current street 

address and phone number in case they need to 

contact you. 

■ Make arrangements for backup transportation to your 

dialysis facility.

■ Get information about other dialysis facilities in your 

area. Find out if they provide the type of treatment you 

need. Contact the facility to be sure they can treat you if 

an emergency occurs and you cannot use your 

regular facility.

If you get home hemodialysis:

■ Contact your water and power company ahead of time to 

register for special priority to restore your lost services. 

Keep their phone numbers up-to-date and easy to find.

■ Keep a flashlight and batteries near your dialysis 

machine.

14
If you use Chronic Ambulatory Peritoneal Dialysis

(CAPD):

■ If you use an ultraviolet device, keep the battery charged

at all times. The battery pack should last for 3 days.

■ Keep a 5-7 day supply of peritoneal dialysis supplies at 

home. Check expiration dates and replace as needed or 

every 6 months.

If you use Continuous Cyclic Peritoneal Dialysis

(CCPD):

■ If you use a cycler, you may want to purchase a gasolinepowered generator that makes 110 volt AC alternating 

current. Or, if you have a car, you can run your cycler off 

the cigarette lighter by using a 12 volt DC to a 110 volt 

AC invertor (available at electronics stores). If the car is 

in a garage, make sure there is plenty of fresh air and 

good ventilation. 

■ If you learn how to do manual CAPD, you will not need a

generator or invertor. If you lose power and don’t have a 

generator, switch from CCPD to manual CAPD.

■ Keep a 5-7 day supply of CCPD (and CAPD if you have 

learned to do manual CAPD) supplies. Check the 

15
expiration dates and replace as needed or every 6 

months. If you work outside of your home, keep a 5-7 day

supply at work.

■ Contact your water and power company ahead of time to 

register for special priority to restore your lost services. 

Keep their phone numbers up-to-date and easy to find.

16
Step 3

Prepare an Emergency Stock of Supplies,

Medicines/Medical Supplies, and Food

Keep your emergency supplies together. You may want to

designate a box or some shelves for your emergency supply.

Check and restock every 6 months.

Emergency Supply List

__ measuring cups, teaspoons and tablespoons, dropper

__ plastic knives, spoons, forks

__ pack of napkins and paper plates

__ pack of plastic or styrofoam bowls

__ paper towels

__ pack of plastic cups

__ candles

__ matches

__ can opener (manual)

__ baby wipes

__ sharp knife

__ flashlight & batteries

__ scissors

__ garbage bags

__ plastic jug for storing water

__ 1 small bottle of household chlorine bleach

__ piece of cloth, cheese cloth, or handkerchief

__ strainer

__ extra pair of eye glasses (in case first pair breaks)

__ radio & batteries

17
Emergency Medication/Medical Supply List

__ first aid kit

__ 5-7 day supply of all your medicine(s)

__ 5-day supply of antibiotics (if you use peritoneal dialysis 

and recommended by your doctor)

__ Diuretics (fluid pills), sorbitol, and Kayexalate for 

potassium control (if recommended by your doctor)

Also, if you are diabetic:

__ 5-7 day supply of syringes 

__ 5-7 day supply of insulin (Keep cool but do not freeze. 

Best kept refrigerated, but will keep at room 

temperature for up to one month.)

__ 5-7 day supply of glucose monitoring supplies like lancets

and alcohol wipes.

__ If you use a glucose meter, have spare batteries and 

test strips.

If you have heart disease:

__ 5-7 day supply of all blood pressure, heart, or anticlotting medications.

NOTE: If you use a mail service pharmacy, have them send

your medicines a week before you run out. Allow extra time

for processing and mailing back to you.

Also, keep a supply of medicine at your work place or any place

you spend a great deal of time, like a family member’s home.

18
Emergency Food List (See Emergency Diet Plan on

pages 22-27)

This list provides a 6 day supply of canned foods and water.

Use fresh foods as long as they are available.

__ 3 packages of dry milk OR 4 – 8 ounce (oz.) cans 

evaporated milk

__ 1 or 2 gallons of distilled or bottle water

__ 2 packages powdered fruit-flavored drink mix OR 1 

container fruit-flavored drink (pre-mixed)

__ 1-2 cans or bottles of soft drink

__ 6-pack of 4 oz. cans or boxes of fruit juice (cranberry, 

apple, or grape)

__ 6 boxes of single-serving cereal (No Raisin Bran)

__ small box white sugar (or box of sugar packets)

__ 12 – 4 oz. cans or “fruit bowls” of fruit (pears, peaches, 

oranges, mixed fruit, applesauce, or pineapple. NO raisins)

__ 6 – 8 oz. cans of low sodium vegetables (carrots, green 

beans, peas, corn, or wax beans)

__ 6 – 3 oz. or 4 oz. cans of low sodium meat (tuna, crab, 

chicken, salmon, or turkey)

__ 1 jar peanut butter

__ 1 small jar jelly or honey

__ 3 small jars mayonnaise (or 8-12 single-serve foil 

wrapped packs)

__ 1 loaf regular bread* (not salt-free, with NO preservatives) 

__ 1 box vanilla wafers OR graham crackers

__ 5 packages of candy (sourballs, hard candy, jelly beans, 

or mints)

__ 1 package marshmallows

__ 1 jumbo pack of chewing gum

*Bread can be kept frozen for 3 months.

19
Step 4 

Know What Emergency Diet to Follow if Your

Dialysis Might be Delayed

Dialysis takes the waste from your blood. Wastes and fluid

build up between dialysis treatments. Normally this build

up is small and does not cause a problem between regular

dialysis treatments. If your dialysis must be delayed, these

wastes and fluids can add up and cause problems. To keep

the build-up of protein wastes (BUN), potassium, and fluid

as small as possible, you need to follow a special strict diet.

This diet plan is not a substitute for dialysis.

The 3-Day Emergency Diet Plan (developed by the Northern

California Council on Renal Nutrition) limits your protein

(meat, fish, poultry, and egg), your potassium (fruits and

vegetables), salt, and fluid intake more strictly than your

regular renal diet. This diet provides about 40 grams of

protein, 1,500 milligrams (mg) of sodium, and 1,500 mg of

potassium per day. 

If you can’t get dialysis, your life can depend on limiting the

amount of waste that builds up in your blood by changing

your diet. Look at this diet plan with your renal dietician to

see if it will work for you, or to see if it needs to be modified

to fit your special health needs. This gives you a chance to

ask questions before an emergency occurs. If you are on

CAPD and can’t get to your supplies to do your exchanges,

20
this emergency diet may also apply to you. You should

make every attempt to get dialysis within 3 days. But

if it takes longer, be sure to continue the 3-Day

Emergency Diet Plan until you can get your dialysis

treatment.

The meals can be stored and prepared with little or no

refrigeration. If your refrigerator is still working, use fresh

milk, meat, and poultry in the amounts listed in the diet.

Your food may stay fresh for a few days if your refrigerator

is not working if you limit the times you open its door. Use

the fresh food first, before you start to use the canned food.

One egg or 1 ounce of meat that has been kept at a safe

temperature can be switched for 2 tablespoons (tbsp.) of

peanut butter or 1 oz. of low-sodium canned meat.

21
3-Day Emergency Diet Plan

DAY ONE (Add 4 oz. of water to take medicine)

Breakfast

Cereal and fruit:

1/2 cup milk or mix 1/4 cup evaporated milk with 1/4 cup 

distilled water from sealed containers or disinfected water

1 box of cereal (single-serving) (No Raisin Bran)

1 tbsp. sugar

1/2 can (2 oz.) canned peaches (drained)

Morning Snack

Vanilla wafers (5) or graham crackers (1 1/2 squares)

Sourballs (10)

Lunch

Peanut butter and jelly sandwich :

2 slices of bread 

2 tbsp. peanut butter

2 tbsp. jelly

1/2 cup canned pears (drained)

4 oz. (1/2 cup) pre-made powdered fruit drink

Afternoon Snack

Marshmallows (10)

1/2 cup canned applesauce

22
Dinner

Chicken sandwich:

2 slices of bread 

1/2 can (2 oz.) canned low sodium chicken*

2 tbsp. mayonnaise*

1/2 cup canned low sodium carrots (drained)

1/2 cup cranberry juice

Evening Snack

Jelly beans (10)

Vanilla wafers (5) or graham crackers (1 1/2 squares)

*Perishable item: Throw away unused food in open

containers if not refrigerated or used within 4 hours.

If you are diabetic, avoid the sweets in this diet plan.

However, have some high sugar content foods like hard

candies in case you go “low” with too little sugar in

your body.

23
DAY TWO (Add 4 oz. of water to take medicine)

Breakfast

Cereal and fruit:

1/2 cup milk or mix 1/4 cup evaporated milk with 1/4 cup 

distilled water from sealed containers or disinfected water

1 box of cereal (single-serving) (No Raisin Bran)

1 tbsp. sugar

1/2 can (2 oz.) canned pear (drained)

Morning Snack

1/2 cup canned applesauce

Jelly beans (10)

Lunch

Chicken sandwich:

2 slices of bread 

1/4 cup (1 oz.) canned low sodium chicken 

1 tbsp. mayonnaise*

1/2 cup pineapple (drained)

4 oz. (1/2 cup) pre-made powdered fruit drink

Afternoon Snack

Mints (10)

1/2 cup canned applesauce

24
Dinner

Tuna sandwich: 

2 slices of bread 

1/2 can (2 oz.) canned low sodium tuna*

1-2 tbsp. mayonnaise*

1/2 cup canned low sodium peas drained

1/2 cup cranberry juice

Evening Snack

Vanilla wafers (5) or graham crackers (1 1/2 squares)

Sourballs (10)

*Perishable item: Throw away unused food in open

containers if not refrigerated or used within 4 hours.

25
DAY THREE (Add 4 oz. of water to take medicine)

Breakfast

Cereal and fruit:

1/2 cup milk or mix 1/4 cup evaporated milk with 1/4 cup 

distilled water from sealed containers or disinfected water

1 box of cereal (single-serving) (No Raisin Bran)

1 tbsp. sugar

1/2 cup cherries (drained)

Morning Snack

Vanilla wafers (5) or graham crackers (1 1/2 squares)

Hard candies (10)

Lunch

Peanut butter and jelly/honey sandwich: 

2 slices of bread 

2 tbsp. peanut butter*

2 tbsp. jelly or honey

1/2 cup canned peaches (drained)

4 oz. (1/2 cup) cranberry juice

Afternoon Snack

1/2 cup canned applesauce

Jelly beans (10)

26
Dinner

Salmon sandwich: 

2 slices of bread 

1/2 can (2 oz.) canned low sodium salmon*

1-2 tbsp. mayonnaise*

1/2 cup canned low sodium green beans drained

1/2 cup soft drink

Evening Snack

Vanilla wafers (5) or graham crackers (1 1/2 squares)

Marshmallows (10)

*Perishable item: Throw away unused food in open

containers if not refrigerated or used within 4 hours.

27
How to Disinfect Water

Keep distilled or bottled water on hand for drinking. If you

run out of stored water, you may disinfect available water

for drinking, brushing your teeth, or for other uses. Do not

use disinfected water for dialysis.

1. Strain water through a clean cloth or handkerchief to 

remove any sediment, floating matter, or glass.

2. Use 5.25% sodium hypochlorite solution (household 

chlorine bleach). Do not use bleach that has active 

ingredients other than hypochlorite.

If the water is clear, use:

Water Bleach

One quart 2 drops 

One gallon 8 drops 

5 gallons 1/2 teaspoon 

If the water is cloudy, use:

Water Bleach

One quart 4 drops 

One gallon 16 drops 

5 gallons 1 teaspoon 

28
Mix the water and bleach together thoroughly by stirring or

shaking them in a container. Let the mix stand for 30

minutes before using it. The water should have a slight

chlorine odor. If it does not, add the same amount of bleach

again, mix thoroughly, and let it stand for an additional 15

minutes before using it.

NOTE: You may also purify water with rapid boiling for 10

minutes.

Do not use water from a swimming pool or spa

because of the chemicals used to treat the water.

From Water Disinfection and Storage, Pacific Bell 1998.

29
How to Get Off of a Dialysis Machine in

an Emergency Evacuation

Your dialysis facility staff should show you what to do if you

are on a dialysis machine in an emergency. The instructions

should include where your emergency pack is kept and how

to disconnect yourself from the dialysis machine. An emergency pack usually contains scissors, tape, clamps and other

medical items and should be kept within your reach while

you are on the dialysis machine. 

If you are on a dialysis machine during an emergency, stay

calm and wait for instructions from the facility staff.

If no staff person is available to help you or give you

directions, here is what to do. Remember, these directions

are for emergency evacuation situations only. Your

access needles should be left in place until you get to a

safe place. NEVER cut your access needle lines.

How to Clamp and Disconnect

➡ Clamp both access needle lines.

➡ Clamp both of the thicker blood lines. If the lines have 

pinch clamps, pinch all four clamps closed. Cut or 

unscrew the lines between the closed clamps. If you 

must cut your lines, cut ONLY the thicker blood lines. 

30
NEVER, NEVER cut your access needle lines. NEVER

cut the line between the clamp and your access—you

will bleed to death.

➡ If you have a CATHETER, your professional staff should 

assist you. Do not try to disconnect yourself.

Care of Your Access in an Emergency

After you have been disconnected from your dialysis

machine, go to the designated safe area. Wait for directions

from the person in charge. This person could be a dialysis

facility staff member, or emergency personnel such as a

paramedic, police officer, or firefighter. Do not remove your

fistula needles until you have been checked by medical

personnel, or until you are sure that you are in an area out

of immediate danger.

Under no circumstances should any medical

personnel unfamiliar with your dialysis status place

or inject anything into your vascular access.

31
For More Information About:

Medicare Coverage

■ Call 1-800-MEDICARE (1-800-633-4227). TTY users 

should call 1-877-486-2048.

Dialysis Facilities

■ Look at www.medicare.gov on the web. Select “Dialysis 

Facility Compare.” 

Or, call your ESRD Network (see pages 34-35) for

information about:

■ Dialysis or kidney transplants. 

■ How to get help from other kidney-related agencies. 

■ Problems with your facility that are not solved after 

talking to the staff at the facility. 

■ Locations of dialysis facilities and transplant centers. 

Your ESRD Network makes sure that you are getting the

best possible care, and uses mailings to keep your facility

aware of important issues about kidney dialysis and

transplants. 

32
Or, call your State Survey Agency (call 1-800-

MEDICARE (1-800-633-4227) for the phone number)

for assistance if you have problems with the facility that

you cannot solve by talking to the facility staff. Your State

Survey Agency makes sure that dialysis facilities meet

Medicare standards.

NOTE: The telephone numbers on the following pages

were correct at the time of printing. Phone numbers

sometimes change. To get the most up-to-date phone

numbers, call 1-800-MEDICARE (1-800-633-4227). TTY

users should call 1-877-486-2048. Or, look at

www.medicare.gov on the web. Select “Helpful Contacts.”

33
Pages 34-37 of this document are intentionally left blank. They contain 

phone numbers pertaining to this publication. For the most recent contact 

information, visit the Helpful Contacts section of this web site. 
Emergency Instructions

➡ Stay at home, unless you are hurt.

➡ Begin survival diet:

2 cups fluid per 24 hours, no fresh fruit or 

vegetables. See pages 22–27 in your guide for 

detailed diet instructions.

➡ Wait at home for instructions and details about 

dialysis on TV, radio, messenger, or phone.

➡ If you must go to a shelter, tell the person in 

charge about your special needs.

Remember: Hospitals may not be equipped to provide

maintenance dialysis treatments.

CMS Pub. No. 10150

Department of Health and Human Services

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244-1850

www.Medicare.gov

October 1999, reprinted August 2000, revised November 2002

For additional copies, contact your local ESRD Network. A listing is provided on

page 34.