Building Resilience in Hemodialysis Care: A Program Report on the British Columbia Hemodialysis Emergency Support Team.

This program report describes the development and implementation of the Hemodialysis Emergency Support Team (HEST) in British Columbia, an initiative led by BC Renal in partnership with the province's 5 health authorities. The HEST was created in response to the growing risk of climate-related emergencies such as wildfires, floods, and water shortages, with the goal of ensuring continuity of care for patients receiving maintenance dialysis during service disruptions. The report outlines the provincial strategy behind HEST, including capacity building during non-emergency periods, strengthening of routine operations, and insights gained through simulation-based evaluations. Key outcomes include the achievement of provincial consensus, development of standardized staffing models, integration with existing emergency response frameworks, and the creation of rapid mobilization protocols. Beyond emergency response, HEST nurses also serve as mentors and clinical resources during non-emergency times, supporting local teams, sharing best practices, and helping build capacity within the hemodialysis unit. This dual role contributes to both emergency preparedness and long-term workforce sustainability.