New global roadmap developed at The Institute offers practical guidance for disaster preparedness, response and recovery in nephrology care
SOURCE: The Research Institute of the McGill University Health Centre (The Institute)
July 25, 2025
For people living with kidney disease, the consequences of disrupted care during disasters can be life-threatening — highlighting the critical need for systems that ensure continuity. Dialysis patients require ongoing treatment multiple times a week, while transplant recipients depend on uninterrupted access to medications and safe, hygienic conditions. Even brief disruptions can have life-threatening consequences.
Recognizing the urgent need for practical solutions, Shaifali Sandal, MD, scientist in the Metabolic Disorders and Complications Program at The Institute and nephrologist at the McGill University Health Centre, led the development of a global roadmap to help kidney care programs navigate disasters. Her team's work, published in the Journal of the American Society of Nephrology (JASN), offers a practical, customizable framework for disaster preparedness, response and recovery in nephrology settings.
A practical framework for action
To build the roadmap, Dr. Sandal and her team conducted an extensive review of nearly 4,000 publications, analyzing 52 key articles using the Framework Method—a structured qualitative analysis technique. The subsequent roadmap is based on real-world lessons and clinical insights, ultimately drawing on the most relevant insights to identify key strategies for each phase of disaster management. The resulting framework outlines:
- 'ABC4'S' Preparedness strategies such as risk assessment, capacity building, contingency planning, and patient and staff training.
- The 'DIAL' Response protocols to guide teams through damage evaluation, plan activation, and clear communication with stakeholders.
- The 'ARC' Recovery steps focused on returning to care, evaluating what worked, and using data to improve future responses.
"We wanted to develop a practical guide that kidney care teams around the world could actually use," says Dr. Sandal, who is also a member of the Centre for Outcomes Research and Evaluation at The Institute. "It's about being pragmatic, proactive and patient-centered."
While the roadmap was created for nephrology, many of its principles—such as surge planning, coordination, and communication—can also inform disaster planning in other areas of healthcare.
Looking ahead
The next phase for Dr. Sandal and her team is focused on implementation in Canada. They plan to work with kidney care programs across the country and are currently conducting a risk, vulnerability and adaptation assessment. They also want to pursue this work internationally — especially in low-resource and high-risk regions — to adapt and apply the roadmap to local contexts. This will include knowledge-sharing initiatives, interest holder engagement, and the development of training tools to help clinical teams build practical emergency plans.
The roadmap also opens the door for future research. The team intends to evaluate its impact in real-world settings to refine the framework and inform best practices. With time and collaboration, the roadmap could help shape national and global policies for health system resilience in nephrology — and potentially across other medical fields and sectors.
About the study
The study, "A Roadmap for Disaster Risk Reduction and Management in Kidney Care: A Scoping Review and Content Analysis" by Shaifali Sandal, Saly El Wazze, Diya Nijjar, Isabelle Ethier, Alessia N Paparella, Lindsay Hales, S Neil Finkle, Vivekanand Jha and Caroline Stigant was published in the Journal of the American Society of Nephrology (JASN).
This research was funded by a Planning Grant from the Canadian Institutes of Health Research (PCS 190937).
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