Typhoon & Disaster Preparedness for Dialysis Patients · williamriveromd.com W.G.M. Rivero MD · FPCP · DPSN · · 2026
Emergency Preparedness · Dialysis Patients
Typhoon & Disaster Preparedness
for Dialysis
Philippine typhoon season (June–November) poses life-threatening risks for dialysis patients. Covers: missed sessions, emergency protocols, go-bag essentials, fluid management, and safe evacuation.
⛑️
W.G.M. Rivero MD
FPCP · DPSN
Nephrologist
williamriveromd.com
20+
Typhoons/Year in PH
48 hrs
Max Safe Missed HD
Go-Bag
Always Ready
Call First
Dial Center
1PAGASA Typhoon Signal — Action Guide for Dialysis Patients
PAGASA Signal Wind Speed Action Required
Signal 1 30–60 km/h Prepare go-bag; confirm next dialysis schedule; stock 2-day emergency food
Signal 2 61–120 km/h Call dialysis center now — confirm if open; fill fluid allowance bottles; charge phone
Signal 3 121–170 km/h Go to pre-arranged evacuation point if center is closed; do NOT attempt travel in flood
Signal 4 171–220 km/h Shelter in place; contact Red Cross or DSWD for emergency dialysis; restrict fluids strictly
Signal 5 >220 km/h Catastrophic — follow emergency broadcast; restrict all fluid and potassium intake

⚠ If Your Dialysis Center is Closed

Do NOT skip meals to compensate. Instead: restrict fluids to absolute minimum, avoid ALL high-potassium foods (buko water, banana, kamote tops), and seek emergency dialysis at the nearest open facility.

For educational use only. This guide does not replace your nephrologist's personalized emergency plan. Always carry your dialysis center's emergency contact. References: PAGASA Public Storm Warning Signals · Philippine NDRRMC Emergency Guidelines · KDIGO Disaster Preparedness Resources 2024. williamriveromd.com
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Typhoon & Disaster Preparedness for Dialysis Patients W.G.M. Rivero MD · FPCP · DPSN · williamriveromd.com · 2026
PAGASA Typhoon Signal Levels and Preparation Actions
PAGASA typhoon signal levels and corresponding actions for dialysis patients
Fig. 1 — PAGASA typhoon signal levels and corresponding actions for dialysis patients. Begin preparing at Signal 1 — do not wait until Signal 3 to act. Pre-arrange an alternative dialysis center and evacuation route before typhoon season (June–November).
For educational use only · Not a substitute for individualized medical advice · williamriveromd.com williamriveromd.com
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Dialysis Go-Bag · During the Typhoon
Be ready before the storm — not during it
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2Dialysis Go-Bag — What to Pack
💊 Medical
✓ 3-day supply of all medications (labeled by dose/time)
✓ Copy of prescription and lab results (most recent)
✓ Emergency contact: dialysis center + nephrologist number
✓ Dialysis schedule card (next 3 sessions with dates/times)
✓ Medical alert bracelet or card stating "Dialysis Patient"
✓ BP monitor (manual preferred — no batteries needed)
✓ AV fistula care: sterile gauze, medical tape, gloves (in case of bleeding)
✓ PD patients: 2 extra bags of PD solution + transfer set + cap
🍚 Food & Fluid
✓ 500 mL water (within your daily fluid allowance)
✓ Low-potassium snacks: 1 cup cassava, plain crackers (low-sodium), hard-boiled egg
✗ AVOID packing: buko water, banana chips, dried fruits, nuts
🎒 Essentials
✓ Fully charged power bank + phone charger
✓ Small flashlight + batteries
✓ Cash (₱500 minimum — ATMs may be offline)
✓ Extra dry clothing in waterproof bag
✓ Copy of PhilHealth ID and dialysis center membership card

⚠ PD Patients — Power Outage Warning

If power is out for >4 hours, keep your PD solution at room temperature — do NOT use solution that has been exposed to extreme heat or flood water. Use backup manual exchanges if cycler is unavailable.

For educational use only. Medications, go-bag contents, and emergency plans should be reviewed with your nephrologist before typhoon season. Keep your go-bag packed June–November at all times. williamriveromd.com
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Typhoon & Disaster Preparedness for Dialysis Patients W.G.M. Rivero MD · FPCP · DPSN · williamriveromd.com · 2026
Dialysis Go-Bag Contents and During-Typhoon Protocol
Dialysis go-bag contents and during-typhoon protocol for kidney patients
Fig. 2 — Dialysis go-bag contents and during-typhoon protocol. Keep this bag packed and accessible at all times during June–November typhoon season. The medical pouch (medications, records, contacts) is the most critical component — physical items can be replaced, but missed dialysis from a lost prescription or closed center can be life-threatening.
For educational use only · Not a substitute for individualized medical advice · williamriveromd.com williamriveromd.com
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Missed Dialysis Protocol · Emergency Diet Restrictions
What to do when you cannot get to your center
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3Missed Hemodialysis Session — Protocol by Hours
Hours Missed Risk Level Actions
0–12 hrs Low Restrict fluids to 500 mL total; avoid all high-K+ foods; contact center for rescheduling
12–24 hrs Moderate Same as above + check for symptoms: swelling, shortness of breath, palpitations → ER
24–36 hrs High Seek emergency dialysis at any open facility; if symptomatic → ER immediately
36–48 hrs Very High Medical emergency — any functioning hospital with hemodialysis
>48 hrs Critical Life-threatening — emergency services (911 / Red Cross: 143)

🚨 Signs Requiring IMMEDIATE ER Visit — Regardless of Typhoon

Chest pain or pressure · Severe difficulty breathing · Confusion or extreme weakness · Puffy face/severe leg swelling · Urine output suddenly stopping

4Emergency Diet Restrictions When Dialysis is Missed
💧 Fluids

Limit to 500 mL/day total (includes soup, ice, medicine water). No buko water, no juices, no softdrinks.

Signs of fluid overload: shortness of breath, inability to lie flat.
⚡ Potassium

Avoid ALL: banana, saging na saba, kamote tops, avocado, buko water, monggo, kalabasa.

SAFE: rice, cassava, kamote (small amount), boiled sayote/upo.
🔬 Phosphorus & Protein

Minimize protein portions. No processed food. No cola drinks (phosphoric acid).

Small portion of egg or tofu only.
5Emergency Resources — Philippines
Organization Contact Service
Red Cross Philippines143Emergency medical transport
NDRRMC Hotline911 / 02-8911-5061National disaster coordination
DOH Emergency1555Health emergencies
PhilHealth02-8441-7444Coverage during emergencies
For educational use only. These protocols supplement — but do not replace — your nephrologist's individual guidance. The 48-hour threshold is a general guideline; some patients may decompensate faster depending on residual kidney function and fluid status. williamriveromd.com
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Typhoon & Disaster Preparedness for Dialysis Patients W.G.M. Rivero MD · FPCP · DPSN · williamriveromd.com · 2026
Missed Dialysis Decision Tree
Missed dialysis decision tree: when to seek emergency care versus restrict diet
Fig. 3 — Missed dialysis decision tree: the critical threshold is 48 hours without hemodialysis. At 24 hours with symptoms, go directly to the ER. Do not attempt to "save" a missed session by restricting diet alone — uremia and hyperkalemia accumulate rapidly without dialysis.
For educational use only · Not a substitute for individualized medical advice · williamriveromd.com williamriveromd.com
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Emergency Disconnection · PD Patients · Post-Typhoon Recovery
Fistula emergencies · PD-specific guidance · Returning to normal care
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6AV Fistula Emergency Needle Disconnection
①
Apply Pressure
APPLY FIRM PRESSURE immediately with thumb or any clean cloth — do not remove
②
Hold 10–15 min
Maintain pressure for at least 10–15 minutes without checking
③
No Tourniquet
Do NOT apply a tourniquet under any circumstances
④
Call for Help
Call someone to help — do not drive yourself to the hospital
⑤
ER if Persistent
Go to ER or call emergency services if bleeding does not stop after 15 minutes

🩸 Life-Threatening: Dislodged Fistula Needle

A dislodged fistula needle can cause life-threatening blood loss in minutes. Practice this response with your family BEFORE an emergency occurs.

7PD Patient Specific Guidance
🔄
Manual Exchanges if Cycler Fails
Use your manual exchange training — 4 exchanges of 2L per day minimum; set phone alarms for exchange times. Practice manual exchanges before typhoon season.
🌊
Flood Water Contamination
If your PD exit site or bags were exposed to flood water — do NOT use contaminated solution; contact your PD nurse immediately for guidance.
⚠️
Cloudy Effluent
Cloudy effluent during/after typhoon may indicate peritonitis — culture effluent and start empiric antibiotics per your center's protocol; go to ER.
8Post-Typhoon Recovery Checklist
✓ Resume normal dialysis schedule as soon as center reopens
✓ Check serum K+, phosphorus, and BUN at your first post-typhoon session
✓ Report all medications taken during the emergency to your nephrologist
✓ Check AV fistula or PD catheter exit site for signs of infection
✓ Gradually return to normal fluid allowance over 1–2 days
✓ Inform your dialysis nurse about any symptoms experienced during the typhoon
For emergencies: Red Cross 143 · NDRRMC 911 · DOH 1555 · For educational use only · williamriveromd.com · 2026 williamriveromd.com
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Typhoon & Disaster Preparedness for Dialysis Patients W.G.M. Rivero MD · FPCP · DPSN · williamriveromd.com · 2026
Post-Typhoon Recovery for Dialysis Patients
Post-typhoon recovery steps for dialysis patients — resuming care, checking labs, monitoring for complications
Fig. 4 — Post-typhoon recovery checklist for dialysis patients. Resume dialysis as soon as your center reopens; do not wait. Post-disaster labs (K+, BUN, phosphorus) are essential at your first session. Report any symptoms experienced during the typhoon to your dialysis team — fluid overload, hyperkalemia, and infection complications may not be immediately apparent.
For educational use only · Not a substitute for individualized medical advice · williamriveromd.com williamriveromd.com
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