Quality Insights Podcast

Taking Healthcare by Storm: Industry Insights with Yessi Cubillo

• Dr. Jean Storm

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In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Yessi Cubillo, ESRD Networks 3, 4 & 5 Regional Emergency Preparedness Coordinator and ESRD Network 3 Patient Engagement Specialist at Quality Insights.


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This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-101824-GK

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.

In each episode, Quality Insights Medical Director, Dr.

Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello, everyone, and welcome to another episode of Taking Healthcare by Storm.

I am Dr.

Jean Storm, the Medical Director at Quality Insights.

And today, we are talking about a topic that is very relevant, given the state of some natural disasters that have occurred lately.

Today, we're going to be talking about emergency preparedness, and something really interesting that I hadn't thought of.

So I am so happy to be joined by our guests today.

We're going to be talking about emergency preparedness for dialysis facilities, for CKD and end-stage renal disease patients.

We have to be really specialized in looking at certain facilities and patient populations.

That is why I am so delighted to be joined by our expert today, Yessi Cubillo, who is a patient engagement specialist for Quality Insights, Renal Network 3 since 2013, and the Regional Emergency Preparedness Coordinator for Networks 3, 4, and 5 since 2018.

A big job.

Mr.

Cubillo is responsible for the patient engagement initiatives for Network 3, as well as case management of dialysis patients and facility concerns, grievances, and discharges.

In addition, Mr.

Cubillo has been instrumental in Network 3, 4, and 5's emergency preparedness, planning, and response, including active involvement in multiple events such as Hurricanes Irma and Maria in the US Virgin Islands and Puerto Rico.

Mr.

Cubillo promotes sustainable partnerships and activities amongst federal and local emergency management representatives, renal community partners, dialysis providers, and other pertinent stakeholders to help the renal community prepare and respond and recover from disasters and emergency events.

So very important today.

I'm going to call you, Yessi.

You can call me Jean.

I hope that's OK.

I love that.

Thank you so much.

OK, Yessi, I'm so glad for you to be with us today.

So tell us how you came to do what you currently do and how you became interested in emergency preparedness.

I have to tell you, my roots kind of started with doing trainings.

One of my very first jobs was doing trainings for families with access and functional needs.

And I will visit them in their homes and create plans for these families and their children and make sure that they were ready.

And just anything they needed was in place so that if they needed to evacuate their homes, if they needed to respond to an emergency, they were prepared and had plans in place so that they could be able to deal with that emergency.

And from there, I connected through Healthcare Coalition in New Jersey with the ESRD Network 3.

And I met one of my colleagues there and that's how I got foot in the door and was able to learn more about what dialysis is and the work that the networks did.

And I got pulled into the work of the network.

And that's how this whole journey that you just described throughout those years has developed for me.

Yes.

And such an important place where you are right now, definitely.

So what are the most common disasters that dialysis facilities should prepare for?

And why are these facilities particularly vulnerable during these events?

Yeah.

I could list you every disaster there is, including floods, hurricanes, which is something that we're dealing with right now, earthquakes, pandemics, COVID-19.

It was a perfect example of that.

Tornadoes, which is something that we see when there is just a small storm, severe storms, winter weather.

I could go down the list of all those different scenarios.

But I think it's important for each dialysis facility to do a hazardous vulnerability assessment of what is it that's going to impact their area, or what has had impacted their area.

My call to dialysis facilities is, and always when I speak to them, is work together with your local emergency management.

They have the knowledge, they have the experience.

Work with them so they can be able to identify what are those events that have currently in the last five years, five in the last decade that has impacted your region and work with them to develop plans that are sustainable, so that you can then make it that your plan responds to that emergency.

Why is it that dialysis facilities are particularly vulnerable?

I think, not that I think I know, it is the fact that they have patience.

And I say this to everyone in every response that we've had and the education that I provide is, dialysis patients are very fragile.

If a dialysis patient goes a certain amount of days without that dialysis treatment, they run the risk of passing away.

And so I think painting that picture for someone who's not aware of what the impact of that vulnerable population is, that continuity of treatment, how important it is for the patients, when you present it to them in a way that speaks of what the end result could be, it definitely creates a new urgency for that emergency response and the collaboration between those that are trying to help and the dialysis facilities, and why the dialysis facilities also need to be prepared.

Absolutely.

And people, I don't think, think of dialysis as a life-sustaining treatment, but it is.

It's dialysis keeps patients alive.

So that needs to be understood.

So can you outline just the basic essential components of an emergency preparedness plan for dialysis facilities?

Yeah.

Dialysis plans should be comprehensive, that ensuring that the life-saving treatments that they're providing for their patients could be sustained during and after a disaster.

I did highlight the component of doing a hazards-vulnerability assessment, and I think that's one of the first steps to take.

But if a facility has not done this just yet in your emergency planning, the very first step before doing the hazards-vulnerability assessment, before doing anything else, I again encourage facilities to coordinate with local emergency services, create agreements with them with those local emergency services, whether it be the police department, the Office of Emergency Management, your fire department, any of them, just make them aware of what's going on at your facility.

Many of them don't understand what dialysis is.

And just as I mentioned earlier, how fragile the dialysis population is, if they miss those treatments, those lifesaving treatments, it does help that in your initial planning stages, as you're developing those plans and you're coming together to develop the foundation of your plans, have those emergency management partners pressing at the table so they can help you then move on with each one of the necessary steps.

Once you have them on board, work on developing that hazardous vulnerability assessment, then you can also create a communication plan, not just for you to communicate with those partners, but a communication plan that encompasses the staff of your facility, encompasses a communication plan for your patients and the families and emergency contacts for the staff and for the patients as well.

So I think that communication plan is essential so that a staff is able to communicate during the emergency, before, during, and after that emergency.

And we can get a little more in-depth into that.

But I have had the experience where even after an emergency, there's always room for improvement.

So those communication plans always have room for improvement even if you have something right now.

The continuity of operations, that's also very important.

Who's going to be your backup provider or supplier for, if you have generators in your facility, who's going to be the supplier for the diesel?

Who's going to be your supplier for water?

How are you going to get the supplies to your facility?

And if that one supplier is not available, who's your backup supplier?

So who's your backup to your backup, basically?

Right, Jean?

And that's something that I like to always say.

You have a plan, but make sure you have a backup to that plan as well, right?

And that continuity of operation also entails the staffing.

If you don't have staff for your facility, you can run the operations of your facility, right?

We always think about the patient, we always think about coordinating with the external partners, but your staffing is also essential and have plans for them, so that if you don't have enough staff for your facility, what are you going to do to help during that emergency?

That staff is also dealing with that emergency.

They have families, they have loved ones that they're going to want to take care of, or if they need to evacuate, they're also evacuating those loved ones, and they're evacuating with those patients.

So have plans in place so that if you are going to continue providing, that your facility is operating, that dialysis center is operating, what is it that you're going to have in place so that you can provide support to that?

And I highlight a quick story from my experience with Puerto Rico and the US.

Virgin Islands during Hurricane Maria.

In Puerto Rico, we had the providers, one of the things they did for their staff is they provided child care.

They did an area in their dialysis center, they separated an area where they dedicated for child care for the children of the staff.

And so it allowed the staff to not leave their children home alone because schools were closed during that emergency.

They were able to come into the dialysis center, continue doing their work, the work that they wanted to do to save the life of these patients.

But then they also, their children were taking care of during the time that they were working, they didn't have to worry about that.

Food was provided for the children as well while they were there.

And so there's also alternatives that I've seen.

Staff put some of their plan is, the staff put some of their essential staff in a hotel close by or in a location close by where after the emergency happens, that staff can come in and assess the dialysis center and the operations of the dialysis center.

So there are different ways that facilities can go about doing this, that continuity of operation.

You could get very granular into the work that they could be doing.

But I think it's important to look at different perspectives.

And when you have different partners at the table to talk about these options, then you're able to be able to develop a sustainable plan.

In addition to that, emergency dialysis options, if your facility closes, part of that plan should be, who is your backup facility?

And if that backup facility is a couple of blocks away from you, most likely that facility is also going to be impacted by that event.

So it's always good, as I mentioned earlier, have a backup to your backup so that the patients have an alternative of where to go.

The transportation and evacuation, all of that falls into the planning.

But a part of the plan is also the patient education and preparedness.

How are you going to prepare your patients in learning what part of the plans you're activating?

What is it that you're doing to make sure that they're safe, and that they're able to continue receiving treatment?

But at the same time, that component of the education of what patients should be doing during that emergency, or before that emergency, and what they need to have available after the emergency so they can continue to receive the treatment.

So it's personal preparedness for the patient, which includes the diet, fluid restrictions, as well as having emergency context available, and the facility also having those emergency contexts.

So I think this is all essential parts of the different components that fall into the dialysis plan and part of the patient's plan.

But ultimately, it's all encompassing of, one builds on the other.

So if the facilities plan doesn't include the patient's education and the preparedness, then there is a missing component of that plan in there.

And of course, what is the post-disaster recovery plan?

How are you going to conduct that damage assessment, that communication between staff, and how are you going to ensure that everyone is on the same page if communications are down?

So that's always important to look at the hassles vulnerability assessment and how those different components of that emergency are going to impact different capabilities of your facility.

And after that, of course, always, those plans are living documents.

They're not something that you just create once, put it on a shelf, and forget about it.

It's a living document.

So after every emergency, make sure that you evaluate how can we do better, and take that and make it a part of your plan, and make it a part of building up your plan, and enhancing those components of your plan.

I tell you what, I love that story, that the facility supplied child care, just staff know that their children are safe, they can do a good job.

So I really appreciate you sharing that.

The living document, I think facilities, all types of healthcare facilities really need to understand that, that these emergency preparedness plans are living document, things are going to change.

We all know the world is dynamic.

So that, that's wonderful.

You know, you shared that it's really important to teach staff, to communicate well with staff and to teach staff how to communicate with patients and emergency providers and all, and all that.

Are there any other key skills you think that staff should be trained on to handle crises effectively?

Yeah, yeah.

I mean, if we, I'm not gonna get into the medical component of it.

I think that's something that nurses and the staff should have planned for.

And it kind of innately comes to them as well when that emergency happens.

But the one skill I think it's also important is understanding the needs of your patients in an emergency.

And that goes across the board.

I was at a meeting where we were talking about emergency preparedness, and it was actually a tabletop exercise.

And we had staff pressing at that meeting.

And when I mentioned to them the emergency take-off procedure for their patients and how that is something that is valuable to the patients, many of the facilities, what they do is they verbally explain it to the patient and think, okay, they yes me and they say, yes, I understand the plan.

I know what to do.

I know what the expectation is if I have to do that emergency take-off for my dialysis machine in an emergency.

But when I said to them, have you actually given them the opportunity to do hands-on training rather than just explain it to them?

They looked at me like, what do you mean?

I share with them a story of a dialysis facility who took the opportunity of waiting to the end of treatment for their patients and waiting for the treatment to finish and said, all right, we're going to practice.

You're going to do the hands-on disconnection of your machine clamping the lines.

You're not going to cut them, you're just going to clamp and do this.

And every step up to the point where you're going to cut them just so that you could feel comfortable if you ever need to disconnect from your machine, you have the hands-on experience.

And I'm very visual as well.

I'm a hands-on person.

So that spoke to me directly, Jean.

And having that and passing that knowledge on, when I share that with them, they're like, I never thought about that.

It is something that had not occurred to me to make sure that I took it a step beyond that.

And taught my staff, this was a facility minister, to talk to my staff or share with my staff the option of doing a hands-on opportunity.

So I think one of the skills that also need to be in places, understanding and boosting the confidence of your patients to be able to manage their own emergency response steps and emergency response initiatives.

Anything that has to do with preparedness, just building that confidence in the patients and building the confidence in the staff.

Because, I mean, there are different scenarios.

And when that scenario plays out, depending on if it's happening in the facility, there's only a limited number of staff at the facility versus a larger number of patients at the facility.

So if that staff is busy attending to other patients, but want that staff, that patient can then take the initiative of, I'm going to start disconnecting myself.

I don't have to wait for my staff to come to me.

It helps them be able to then attend to those that are mostly in need.

So yeah, I can go out down a whole list of different skills, but I think one of the essential ones is the staff having the skill and the capability of identifying who are those patients that I can train and provide those opportunities to, as well as who are the patients who I have to follow a little more closely and provide that extra support to as well.

I love that.

I think that's wonderful.

Really, it's patient-centered care, finding out what patients can do.

I agree.

So I know dialysis facilities during a disaster are concerned with managing resources, supplies, medications, and equipment.

I'm sure you supply these facilities with resources of how they can effectively manage all of these supplies during a disaster.

Yeah.

So supplies-wise, we as the network, we've gotten calls in the past where they say, oh, look, I'm short on this or I need this supply.

We personally, we don't provide those supplies for the facilities.

But as I mentioned earlier, my suggestion is always have those contacts established with the coalitions.

The healthcare coalitions in your region includes multiple organizations who have accessibility to supplies.

For example, when we had COVID-19, a lot of the things we were looking to need for was mask, PPE, and gloves, and different supplies that were needed at the facilities.

So these healthcare coalitions have access to different partners who have stockpile of these supplies.

And so when there was an overload of stockpile somewhere, they put it out to the whole healthcare coalition and say, hey, who's in need of these supplies?

So they were able to kind of share that information with them.

Ultimately, a part of the facilities' management of their resources and medications, supplies, and equipment for an emergency should encompass a few steps, and that is to create and maintain an emergency stockpile.

I know that oftentimes people wait until that emergency happens and the need for a certain supply becomes eminent, that they then start stockpiling and maybe creating more of a burden on that situation, but it is always good to create and maintain an emergency stockpile of whatever resources you constantly are using at your center.

Conducting a regular resource audit and rotating those resources as well, establishing supplier relationships, and backup agreements.

I mentioned earlier how having the supply for water and diesel, at least essential for the dialysis facilities.

If you ask anybody that works in emergency management world and dialysis facilities, the primary two supplies that will come to mind is diesel for generators and water to provide the treatment for the patients.

And so if a dialysis facility has established relationships with the suppliers that are going to deliver that water, and the suppliers that are going to deliver that diesel, it is always good to have the backup to the backup to the backup.

And we saw that, we see that very often in emergencies when that facility is not able to access that water from the initial supplier, they have to go through that backup so they can be able to get the resources.

And if that falls through because of some government situation or blockage of some sort that's impacting your suppliers, being a part of those health care coalitions, they have direct contact to the local government, to the state level government and federal government as well, where they can pass the information on from their side, as well as the network side, to be able to assist with resources and supplies needed during that emergency.

I think that's really interesting.

We don't talk a lot about, or I don't think a lot about dialysis facilities engaging with the community.

And you stressed how important it is for them, for dialysis facilities to have a relationship with community coalitions.

So can dialysis, should dialysis facilities engage with the community to raise awareness in emergency preparedness, is that important to do?

It's definitely an important component of raising awareness to the community.

And as I said earlier, I worked, my roots started by doing education to families who had children with access and developmental needs.

And I never came across in that whole time with someone who was on dialysis.

And so dialysis was like almost like a foreign topic to me.

And when I was introduced to the network, I kind of had to start learning what dialysis was, becoming familiar with dialysis.

It was a learning curve for me as well to familiarize myself with dialysis.

And you will be surprised how often this happens.

Example, we were responding at an emergency.

And we brought the request of we need water for this dialysis centers.

And so someone that was doing the intake said to us, all right, there's a couple of cases of water over there.

Would that be enough to provide dialysis to the patients?

And so that kind of remark shows you that there is opportunity out there for continued education even of those people who are working in the emergency management world.

And in my trainings, I also did trainings in my roots.

I would do training for emergency management partners.

And I wish at that time I had known more about dialysis because I would have been able to pass that knowledge on to them.

So my suggestion is to providers in promoting that education, raising awareness, host community education workshops, do events that connect to the community.

When there is an event in the community where families are gathering, it doesn't hurt to have a representative there speaking about dialysis, about CKD, and collaborating with the Department of Health, who's always providing education on diabetes and other conditions.

So partner up with them and bring dialysis to the forefront.

And it's not because you're doing it to promote a business or to promote the work that you're doing, it's to promote and bring awareness to dialysis.

Coordinating with the local emergency response teams, they provide training to CERT teams, the community emergency response teams.

Those are volunteers from the community.

Many of them are not aware of what some of these conditions are.

And so allowing them the understanding and raising that awareness of what dialysis is and the needs of the dialysis community and how you guys are prepared to respond.

But at the same time, you need that helping hand is essential.

Utilizing social media, digital platforms, that's very big nowadays with what do you call it?

Instagram, Facebook, TikToks is something huge.

I think you hear about patients on the transplant waitlist who go on TikTok, create videos to promote their request or wanting to get that kidney transplant.

It has been successful for some people.

So use social media to your advantage too.

You see teachers doing funny videos, promoting education, promoting different styles of education.

Why not go out there and think outside of the box and start doing something that is positive and brings awareness to what dialysis is, brings awareness to transplant, brings awareness to home dialysis just as we do for every project, but essentially bring awareness to how patients, how facilities, and how everyone can work together to understand the condition and understand that response effort that takes place for facilities.

Adding to doing drills and simulations as well, that is also important to include, as I mentioned at the beginning, when you do those drills and those exercises, bring external partners.

I'm a big advocate in including patients in every effort.

The drills that you're doing in your facility, if you think it's just for the staff, if you think it's just for external partners, have patients present at that exercise because they are the ones who the event is impacting.

You want to hear directly from the patient's voice, how is this event that you evaluated in your hazard vulnerability assessment, how is that also going to impact me, and can help you create better plans for us and for your facility?

Yeah.

I love that you brought up the positive aspects of social media.

It's always negative, but I agree, positive as well.

So I just wanted to shift as we finish up here, just talking about, you talked a little bit about empowering patients themselves.

So what are some key steps that dialysis patients can do for themselves to prepare for a disaster, just personally?

Yeah.

First, I think, and this is me putting my early days hat on again, but it is important for everyone, to patients, staff, everyone is always important to create that emergency kit.

Take ownership of your emergency preparedness.

I always used to say that when in my early days of working with families, I would go to events like community events and try to promote emergency preparedness.

I would say, hey, I will come to your house and I'll do your emergency planning for you and all of that.

I felt like a salesman trying to sell them something that was free.

I was doing it for free, and a lot of people would take on it.

But the one time they would actually take me up on the opportunity to do this, is when there was a hurricane or there was some event that had recently impacted the region.

I always say, don't wait for that emergency to happen.

Look what happened over here, look what happened over there.

Don't wait for that to happen close to you.

Take the initiative, take the ownership of your emergency plan and start by creating an emergency kit, whether it be to have additional supplies of medications, writing down what those medications are, the medical, your medical information.

If someone comes to your home or you go to a shelter, you go somewhere, they don't know anything about you, and now you're going to have to start filling out information.

You're going to have to start completing applications and everything.

But if you have that information readily at hand, if you have your medications written down, if you have the essential supplies that you need, the description of what it is that your treatments are, all of that information, if you have it readily at hand in an emergency plan, you're able to then refer to that.

It makes it easier and less stressful on you as a person, but it also makes it easier on those that are providing the support.

Your dialysis plan, I think is also important to understand, and that goes hand in hand with the dialysis facility.

If you don't know, if a patient doesn't know who their backup facility is in case of an emergency, they need to reach out to their facility and say, hey, I don't know this information.

You might have shared it with me at one point, but I don't remember and I have nothing inviting or I can't remember where it is.

But just approach them and say, I need this information.

If I'm struggling to find it and some of my peers are also struggling to find it, then that means this is an opportunity to be able to create better plans and provide us with a different source of information where we can obtain the backup facility, our important phone numbers that we need to be calling when our facility is closed, or if we're home and we're trying to find out if our facility is open, what are those numbers that we need to be reaching out to?

I think oftentimes patients don't see the network as a resource, the ESRD networks as a resource, but I'm here to just say yes, use this as a resource.

If you're not able to communicate with your facility, if that plan that you have in place is to evacuate and go to another state and you have to do it because it was last minute in your facility, you're not able to contact them and you're not able to establish communication, contact the network, have those numbers available as well so that you could reach out to the network.

We want to make sure you're okay and that you're going to be able to receive treatments and continue to follow the process that you're following during that emergency.

Transportation plans, if your facility is closed, or your initial, not closed, I'm sorry.

If your transportation company that usually provides transportation to you is seizing operations during that period of time, it is good to have a backup plan.

Who is it that you're going to depend on to get you to dialysis?

I know this is a huge topic when it comes to emergency management and emergency preparedness.

Transportation is one of the high topics up there.

It's one of the most difficult ones to fine tune.

But if you as a patient have a plan for how to get to that dialysis center, you're going to be able to make it happen.

I did see during emergencies where patients help patients, and they themselves were there to support one another.

Houses of worship were available to help one another as well and provide some assistance to the patients while that public transportation became reliable again.

But it's always good to have friends, family members, community resources available as part of that response plan.

Staying informed about your local resources is extremely important for patients.

If you are dealing with a power outage, if you're dealing with an emergency about water shortage, whatever it is, if you're a home dialysis patient and you're dealing with different scenarios as well, it is always important to look at what that component of your emergency plan is that you can collaborate with your dialysis center, but also how you can take advantage of some local resources to help you deal with that emergency.

And so, Jean, I can stay here and talk and continue giving more and more, but that's kind of the basics of emergency management planning and some of the steps individuals can take to better prepare for emergencies.

But I think at the end, I think it's important.

Speak to the dialysis center, work hand in hand with them to develop those personal plans because they have the knowledge and they have the resources to also help you with that.

Yeah, great tips.

And last question, I just was hoping you could just touch on, we have Jillian Pate has been on the podcast many times.

She is a renal dietitian working in West Virginia.

So I certainly, as maybe a teaser to that podcast, I look forward to getting her thoughts on this question.

So dietary tips, you know, diet is important for patients who are on dialysis and CKD patients.

So any tips maybe that, you know, for dialysis patients and CKD patients to maintain their health during a disaster, you know, when fresh food may be limited?

Yeah, yeah.

I'm not a dietitian by trade, so I cannot get into the weeds of it.

And that's maybe, like you said, planning the seed for that next podcast and getting more information about that from someone who's a professional on the topic, more well-versed on the topic.

But what I can say is from the emergency management perspective is patients need to have plans for what's going to, how am I going to manage my fluid intake during that emergency?

Before the emergency happens, that fluid intake needs to start happening beforehand.

Patients don't want to lose track or control of that fluid intake, controlling the levels of potassium, sodium, phosphorus.

Sticking to that dietary plan is very, very important so that they don't risk their health during that period of time.

They don't know if tomorrow, I think that's what I mentioned at the beginning, the complexity and how vulnerable this population is.

They need to start thinking about themselves before that emergency happens and activating their plans before that emergency happens.

Because tomorrow, they might not be able to get dialysis.

If tomorrow they're not able to get dialysis, what could I have been doing for myself with my dietary intake to help me sustain and hopefully, be able to make it to the next day so that I could be able to get that treatment.

It is important to have that dietary plan, work with a dietician at the dialysis centers so that they can have that plan set in place and understand what their needs are during that emergency.

But I think if a patient also goes to a shelter, and part of the evacuation that they have is go to that shelter, shelters oftentimes don't keep into consideration the dietary needs of dialysis patients.

So it is important for you to, although they're serving this type of food, you need to also understand that you're not, you shouldn't be eating that, that you need to be able to keep to certain foods, certain amount of fluid intake, and speak to them and see what different accommodations could be made if possible.

So that's really my biggest suggestion is just work with your dietician, speak with them and work to make it so that that plan is specific to your needs and how you can then respond to a future emergency.

Yessi Cubillo, thank you so much for being with us today.

You are certainly saving lives every day, and I am glad to know that people like you are doing what you're doing.

How can, if someone has information, questions, how can they find out more information on this topic?

If you are looking for more information, I highly suggest visiting your network website, each where there are 18 ESRD networks all across the United States.

Look up ESRD networks, and there you'll be able to identify there's a map.

The NCC, National Coordinating Centers, has a beautiful map in there with the contact information for each one of the networks.

But we work for network 3, 4, and 5.

So, if you go to QIRN3 or QIRN4 or QIRN5, you're able to get the information for each one of our 3 networks directly and look at the different projects that we're working on, the different resources that are available.

I also highly suggest for emergency management, visit KCER.

That's K-C-E-R.

They are the national presence for all emergency management for dialysis community.

So visit their website for additional resources as well.

And I'm always available and here to provide a guiding hand or some resources if there is a need for it.

So thank you so much, Jean, for having me and for this great opportunity.

Yes.

Wonderful life-saving information.

Thank you again, Yessi Cubillo.

Thank you.

Thank you for tuning in to Taking Healthcare by Storm, Industry Insights with Quality Insights Medical Director, Dr.

Jean Storm.

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