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The Role of the Disaster Relief Pharmacist
Eiko KOBAYASHI Pharmacist M.S. Pharmacy / International Medical Relief Department Japanese Red Cross Medical Centre
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FIP2012-Amsterdam
Overview
§ Red Cross and Red Crescent (RC/RC) Disaster Management
§ Japanese RC Society (JRCS)
§ Disaster response - Domestic - International
§ Disaster Relief Pharmacist
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International Red Cross and Red Crescent Movements
Fundamental Principles
ICRC (1863)
States 193
RC Conference
Federation (IFRC)
(1919)
National Society 187
Universality
Impartiality
Neutrality
Voluntary Service
Unity
Independence
Humanity
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FIP2012-Amsterdam
§ Trained technical specialists § Uses pre-packed sets of standardized equipment. § Designed to be self-sufficient for one month and
can operate for up to four months
ERUs § Logistics § Relief § IT & Telecommunication § Water & Sanitation
§ Basic Health Care § Referral Hospital (Field Hospital) § Base camp
ERU: Emergency Response Unit
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FIP2012-Amsterdam
§ General Clinic (minor surgery, observation) § Mother and Child Health § Vaccination
Health Units Volunteer
Family, individual
The third level hospital
District Hospital Field Hospital ERU
Primary Health Care Center Health Office
BHC-ERU
Health Care ERUs in the Health System
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FIP2012-Amsterdam
Japanese Red Cross Society (JRCS)
§ International network - One of 187 National Societies - Community based activity
§ Domestic network - Head Quarters - 47 chapters - 92 hospitals - Designated Public Corporation
under “the Disaster Countermeasures Basic Act”
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FIP2012-Amsterdam
JRCS Domestic Disaster Management
§ Medical relief teams - Nationwide & locality based network - Standardized emergency medical kits in handy-carrying case (100patients for 2 days)
§ dERU (domestic Emergency Response Unit) - Standardized equipment - Specialized medical relief team
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FIP2012-Amsterdam
JRCS International Medical Relief Response
n 5 core hospitals: International Medical Relief department - Specialized and trained personnel: Pharmacist capacity - Starter Medical kits: maintained by Pharmacist at the JRC medical center - Basic Health Care ERU Equipment and medicines - IEHK: Interagency emergency Health Kit
• JRCS • BHC-ERU • delegates training
• Community-based Disaster Preparedness
Emergency Readiness System
• Emergency Appeal • ERU team
• Delegates • Equipment
Emergency Relief
• Basic health Care support • Community-based healthcare activity • Psychological Support
Recovery Assistance
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FIP2012-Amsterdam
“Disaster Relief Pharmacist” in Disaster Cycle
Impact
Ì Recovery & Rehabilitation
Acute Phase
(1-3 weeks)
Chronic Phase
(2-3 years)
Silent Phase
Ì Prevention& Preparedness
• Planning
• Training
• Stockpiling
Ì Emergency Response • Search &Rescue
• Medical assistance
Triage & Management �
• Triage • Treatment • Transportation
Disaster Preparedness 3Cs Community Communication Coordination
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FIP2012-Amsterdam
Pharmaceutical support by Pharmacist in JRCS
JRCS Domestic Medical Relief Standardized Medical Relief Team domestic Emergency Response Unit
JRCS International Medical Relief Starter medical kit Emergency Response Unit
Tokyo Metropolitan Disaster management
EDUCATION
on Emergency Medicines Individual Health Kit / ERU training
Disaster Relief Pharmacist
Management of Emergency Medicine Kits by running- stock system
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FIP2012-Amsterdam
§ Individual medical kit for International activities l Briefing and Debriefing with medicine information l Specific medicine information
ü Malaria ü PEP (Post Exposure Prophylaxes)
• STIs • HIV/AIDS
Support for individual delegates as JRCS Pharmacist
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FIP2012-Amsterdam
Interagency Emergency Health Kit (IEHK) 2006
Ecumenical Pharmaceutical Network
United Nations Population Fund
ERU training2011_IEHK_Eiko
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FIP2012-Amsterdam
IEHK : Interagency Emergency Health Kit
Supplementary Unit Basic Unit Malaria Module
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FIP2012-Amsterdam
JRCS BHC-ERU Emergency Medical Kit
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Ì JRCS BHC-ERU standardized Medical Kit and Trained Delegates
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FIP2012-Amsterdam
dERU deployment for the Great East Japan Earthquake 2011
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FIP2012-Amsterdam
JRCS Pharmacists contribution on the Great East Japan Earthquake Response 2011
§ On disaster site - Medical Team: 3-7 days rotations ü dERU outpatient clinic ⇒ Mobile clinic ⇒ satellite pharmacy, etc.
- Support to local Pharmacists: 7days rotations ü Pharmacy services support at emergency clinics and hospitals
§ Outreach support - Delegates and on site Pharmacy operation
§ Local situation and needs changes/reporting § Consumption monitoring for replacement
§ Medicine supply and logistics Support § To medical team for the stock replacement § Challenge for centralized supply chain at local core pharmacy § Coordination with logistics and the JRC HQs
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FIP2012-Amsterdam
INTERNATIONAL MEDICAL RELIEF
Disaster Response
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Local Hospital, Pakistan
IFRC Field Hospital
• Physiologist wheel chair, crutch
• Psychologist Antidepressant
• Nutritionist Nutrition, Vitamins
DMC : Disaster Management Cell
IFRC
Community Pharmacy
Medical Logistician
needs supply
Logistics of Medical Supplies -Pakistan Earthquake in 2005-
Surgical Patients
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FIP2012-Amsterdam
Medicine Supply Medicine has culture…
§ WHO Guidelines for Drug Donations
§ WHO Model List of Essential Medicines
§ Standardized List - JRCS BHC-ERU medical kit - Interagency Emergency Health Kit (IEHK) - Emergency Item Catalogue (ICRC/IFRC)
§ Local procurement
NO Double Standard!! Respect of National standard or Global standard !!
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FIP2012-Amsterdam
Medical Logistician in IFRC (the International Federation of Red Cross and Red Crescent Societies)
JRCS Basic Health Care-ERU Team
Medical Logistician Medical Logistics (Med Log)
Team leader
2 physicians 2 Nurses/ midwives
Nurse/ Pharmacist
Admin Technician
Logistician
Head Nurse
Logistics
Water/ Sanitation
Health
(Med Log)
Operational National Society Local Ministry of Health
Other NGOs
( Med Log)
Hospital ERUs Med Log / Pharmacist
IFRC
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FIP2012-Amsterdam
Medical Logistician
§ Warehouse management : IFRC standard rule - Organizing, stock control, distribution, documentations
§ Procurement role - Quality issues
- avoid local procurement - how to handle batch recall
- Local procurement procedure
§ Donations issue § Import/Export issue
- Controlled medicine; Ketamine, Diazepam, etc. - RDT (Malaria check test) and Malaria medicines
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FIP2012-Amsterdam
n Hospital ERU Outpatient department (OPD) or only for inpatients ü Hospital kit + IEHK + additionals ü Controlled medicines
n Basic Health Care ERU (BHC-ERU) • Clinics (outpatients with observation beds) • Mobile outreach activities ü BHC medical modules + IEHK+ additionals
Additionally… n Cholera kit n Infusions n Vaccines / supplies for vaccination campaign
Medical supplies for Medical Store in ERUs
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FIP2012-Amsterdam
§ Donated medicines from all over the world
§ Local medicines
§ Global standard - Essential medicines - Interagency Emergency Health Kit (IEHK) - Pictogram of medicine bag
ü Respect local culture ü Try to find the local essential medicine list and/or guidelines
Medicines in Emergency
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FIP2012-Amsterdam
Handle with Donated Medical supplies
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FIP2012-Amsterdam
§ Tents: 3x6, 6x6, 6x9(m) § Shipping containers
- Double roofing with ventilation - Only in areas with modest temperatures
↓Temporarily set up then improve
§ Existing building - Room with key lock
Challenges for Medicines Storage on-site
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FIP2012-Amsterdam
§ Security guards - during day and night
§ Outreach activities - for cholera operation
Examples of Medical Store in staff accommodation
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FIP2012-Amsterdam
Initial set-up and locally built shelving
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FIP2012-Amsterdam
Arrangements of ERU boxes
n German BHC-ERU
n Japanese BHC-ERU
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FIP2012-Amsterdam
Stock Management of ERU
§ Set-up centrally managed storage system by supporting nurses
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FIP2012-Amsterdam
Clinic Management of ERU with Local Staff
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FIP2012-Amsterdam
n Working with Local pharmacist/ Technician/ Pharmacy assistant n Respect Local Standards n Provide medicine information to local staff
Pharmacy Management
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FIP2012-Amsterdam
§ Cooperation with local facilities § Management of supplies and local staff § Challenge for the community health
Flexible stances in the field
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Challenges for Community Health
§ Anthelminthic Treatment Program - Planning - Distribution and records - Information to medical staff and patients - Side Effects Monitoring
§ Educating Children on Proper Medicine Use - lecture and brochure in local languages
1. Medicine and snack 2.Medicine form 3.Dosage by ages 4.Blood concentrations and efficacy 5.How it works in your body 6.Schedule and cautions
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FIP2012-Amsterdam
Disaster Relief Pharmacist- Medical Logistician
_Daily Disaster_
Clinical Pharmacist
Pharmaceutical Suppliers
Medical Logistician
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FIP2012-Amsterdam
IFRC Global Logistics Set-up
Geneva Logistics Regional Logistics Country Logistics
Strategy / Planning Coordination Funding HR/Training/ERU Information systems HPC Frame Agreements Reporting & analysis Medicine procurement
Mobilisation Procurement Coordination Fleet services Field logistics set-up Training Logistics network Reporting & analysis
Warehousing Local procurement (except for medicines) Transport Fleet Reporting
Global Logistics Set-up
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FIP2012-Amsterdam
Medical supplies flow-chart
IFRC CENTORAL MEDICAL STORE IFRC Medical Warehouse
REQUISITION Medical stock inventory control and order form
ERU - Medical Store
Waybill Packing list
Pharmacy
STOCK CARDS Medical stock inventory control and order form
Dressing room Order Form
Injection room
Consumption Report Request book
Order Form
Minor surgery theater Order Form
q Warehouse management
q Inventory BIN / STOCK CARD / PC
q Stock estimation q Medicine stock
management
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FIP2012-Amsterdam
Disaster Management Information System -DMIS : Example on Logistics!
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FIP2012-Amsterdam
p Liaise with Logistics p Ensure the warehouse, medical store/pharmacy is set up and managed p Organize distribution of supplies p Monitor consumption and estimate replenishment p Train and supervise local staff on management of medical supplies p Ensure correct disposal of expire/ unusable medical supplies according to local legislation and/or WHO guidelines p Disseminate the importance of Quality assurance and issues related to risks in local purchase
The role of Medical Logistics
Logistics • Right quality • Right quantity • Right cost • Right time • Right place
Information
• Global standard • Local standards • WHO strategies • Disaster Medicine • Culture of
Medicines • Language
Health / Medical activity
• Medical Logistics
Need to be involved from the beginning
Work in close cooperation with Health and Logistics
teams
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FIP2012-Amsterdam
The Role of Disaster Relief Pharmacist in Disaster Preparedness
§ Revise the medicine list - Convenient, less side effects and update
§ Radical improvement of the stock - Running-stock system - PC data base, format of pharmaceutical inventory
§ Capacity buildings by communications - Aware specificity of Disaster Medicine - Developing disaster operation plans - Share expertise in preparing - Management skills - Counseling skill
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FIP2012-Amsterdam
3 Competencies of Disaster Relief Pharmacist p Universal
n International Standard n WHO donation guideline n Essential Medicines n Disaster medicine
p Professional n Expertise of pharmaceuticals n Capacity building
p Interactive & Proactive n Communication n Flexible stances n Medical logistician n Range of activities for disaster operation
Doctor
Admin. etc.
Others
Nurse
Victim
Pharmacist
Medicine
Medical supply
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FIP2012-Amsterdam
Japanese Red Cross Medical Logistics the 1st WORKSHOP in Tokyo ü Date: May 11-13, 2012 (3 days) ü Facilitator: Ms. Selma BERNARDI, IFRC MedLog ü Organizer: Ms. Eiko KOBAYASHI, JRCS Pharmacist ü Participant: 6 Pharmacists in JRCS hospitals + 2 pharmacists observer
AIM: Ø Enhance Pharmacists’ knowledge of Federation logistics procedures Ø Increase JRCS pool of Pharmacists with knowledge in Medical Logistics Ø Introduction to medical logistics procedures for future deployment both with JRCS ERU and Federation
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©IFRC/Jose Manuel Jimenez
Thank you !!