pharmacists role
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The Pharmacists Role
and ResponseSeptember 28, 2005
Sheeba Samuel, Pharm.D.Clinical Assistant Professor
Ernest Mario School of PharmacyRutgers, The State University of New Jersey
Clinical PharmacistHackensack University Medical Center
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Terminology used in Preparation
and Response
Mitigation Measures employed before an incident occurs to reduce
damage
Preparedness Activities that are conducted to improve readiness before a
disaster
Response
Actions that deal with the consequences during a disaster Recovery
Procedures that help normalize business operations
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Federal Disaster Response
Organizations
Federal Emergency Management Agency (FEMA)
National Response Plan (NRP)
National Disaster Medical System (NDMS)
Disaster Medical Assistance Teams (DMATs)
Metropolitan Medical Response System (MMRS)
National Pharmacy Response Team (NPRT)
Centers for Disease Control and Prevention (CDC)
Strategic National Stockpile (SNS)
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Federal Emergency Management
Agency (FEMA)
Coordinates responsibility for all disasters
Provides funding at the request of the governor
Assists state and local organizations to mitigate,prepare for, respond and recover fromemergencies
Developed the federal response plan
Organizes federal assistance into 12 categories Examples: search and rescue, transportation, food, health
and medical services, communication, etc.
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National Response Plan (NRP)
Developed as per Homeland Security PresidentialDirective
Purpose
Align federal coordination structures, capabilities, andresources
Goal
Improve coordination among federal, state, local and tribalorganizations
Template: National Disaster Medical System (NDMS)
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National Disaster Medical System
(NDMS)
Cooperative effort between 4 agencies Department of Health and Human Services Department of Defense Department of Veterans Affairs FEMA
Partnership between federal and private sectors Volunteer based 3 major responsibilities
Provide hospital beds Establish Disaster Medical Assistance Teams (DMATs) Establish specialty DMATs
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Disaster Medical Assistance Teams
(DMATs)
98 state-based teams
35 medical and support personnel: physicians, nurses,pharmacists, paramedics
Process 200-250 patients in 24 hour period 26 considered to be readiness level 1 (R1)
Must meet three requirements
Be adequately trained and equipped Be able to care for themselves
Be fully prepared going into disaster to not add toburden of overwhelming infrastructure
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Disaster Medical Assistance Teams
(DMATs)
Provide four services
Search and rescue
Triage and initial stabilization Provide definitive medical
care
Evacuation
Gaudette R, Schynitzer , George E, Briggs SM. Lessons Learned from the September 11 th World Trade
Center Disaster: Pharmacy Preparedness and Participation in an International Medical and Surgical
Response Team. Pharmacotherapy 2002;22(3):271-81.
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Specialty DMATs
Trauma
Burns
PediatricsVeterinary Medical Assistance Teams (VMATs)
Disaster Mortuary Operation Response Teams
(DMORTs) National Medical Response Teams (NMRTs)
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Metropolitan Medical Response
System (MMRS)
Public and Private sector agencies broughttogether to enhance emergency preparednessand response
Representatives from local police and firedepartments, hospitals, professional organizations,community and state agencies, and federal groups
Required to have well-coordinated plan torespond to emergencies
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National Pharmacy Response Team
(NPRT)
Includes pharmacists, pharmacy technicians, pharmacystudents
Goal: assist in chemoprophylaxis or mass vaccination
Become temporary federal employee
Paid salary
Reimbursed for travel and per diem expenses
Liability coverage outside of state of licensure
Deployed for no longer than 2 weeks Required to complete web-based training program, be
current with treatment recommendations
Application available at: http://ndms.fema.gov/forms.html
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Centers for Disease Control and
Prevention
Prepare and respond to public health emergencies
Conduct investigations into health effects and medical
consequences Assess health and medical needs of disaster victims
Develop and maintain national systems for acuteenvironmental hazard surveillance
Provide epidemiologic, laboratory and other scientificservices to agencies involved in disaster planning andresponse
http://www.in.gov/isdh/bioterrorism/manual/image43.gif
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Strategic National Stockpile (SNS)
Previously known as National Pharmaceutical Stockpile(NPS) established in 1999
Managed by CDC National repository of antibiotics, chemical antidotes,
antitoxins, life-support medications, medical/surgicalsupplies
Goal: Ensure rapid delivery within 12 hours 3 main components
12 hour push packages Enough drugs per packet to treat >100,000 people
Vendor-managed inventory CDC maintains supply of chemical antidotes
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SNS
Can be requested by the state and shipment begin within 12hours pending federal government approval
State responsible to provide manpower to dissemble packagingand transport pharmaceuticals
Must factor in time to distribute Role of pharmacy personnel
Ensure proper storage Provide recommendations for therapeutic alternatives Patient screening and triage
Dispensing of pharmaceuticals Immunizations Patient counseling and compliance
May extend expiration date
http://www.hhs.state.ne.us/images/BT/nps.jpg
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ASHP Statement on the Role of Health-
System Pharmacists in Emergency
Preparedness Pharmacists should play a key role in planning and execution of
Pharmaceutical distribution and control Drug therapy management of patients
Be involved in the following Development of guidelines Selection of pharmaceuticals and supplies for national, regional and local
emergency inventories Ensure proper packaging, storage, handling, labeling and dispensing of
emergency supplies Ensure proper deployment of emergency supply of pharmaceuticals Ensure appropriate education and counseling
Advise public health officials on appropriate messages to conveyto the public
Collaborate with physicians in managing drug therapy
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Commitments made by ASHP
Maintain electronic communications network
Disseminate prompt information to ASHPmembers
Disseminate timely evidence-based informationabout pharmaceuticals
Meet with government officials and others
regarding involvement of health-systempharmacists in emergency preparedness andcounterterrorism
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Key Roles of a Pharmacist in
Bioterrorism
Surveillance
Information
Patient education and counseling
Distribution of pharmaceuticals and medicalsupplies
Administration of vaccines
Evaluation/Triage
Community planning and preparation
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Surveillance
Observe patients and their health needs
Monitor and report any identified increases inpurchases of over-the-counter products forfever, pain or diarrhea
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Information
Remain calm and provide reassurance
Be assertive
Educate public, media and health professionals Prevent irrational behavior
Obtain medication history and allergies
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Patient Education and Counseling
Ensure appropriate use and safety
Prevent toxicities and side effects
Enable identification of other medical andpsychological conditions
Monitor for safety, efficacy and adherence
Monitor for side effects
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Distribution of Pharmaceutical and
Medical Supplies
Obtain extra pharmaceuticals from wholesalers
Keep medications organized and under closesupervision
Maintain security of controlled substances
Package and label appropriately
Prepare drugs onsite Monitor usage of drugs and predict which drugs
need to be ordered
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Administration of Vaccines
Role of pharmacist is moving from distributorof vaccines to administrator of vaccines
Pharmacists must be trained and educated in the
technique of providing immunizations Growing number of pharmacists who are
certified to immunize
Target vaccines associated with bioterrorism: Smallpox
Anthrax
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Evaluation and Triage
Triaging disaster victims
Trauma management
Prevent communicable diseasesAssist in transporting patients to shelters or
homes
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Community Planning and
Preparation
Contact local and state public health and emergencymedical officials to become part of emergency responseteam
Coordinate actions with state board of pharmacy Contact prescription drug benefit plans regarding
protocols for emergency re-fills Set up a handbook of contact information
Wholesalers, distributors, manufacturers, communicationscompanies
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Pharmacy Emergency Response
Team (PERT)
Trained to respond to chemical, biological, radiological, andnuclear agents
Identify a lead pharmacist and set responsibilities for teammembers
Involvement of pharmacy director, administrative support,clinical pharmacists
Establish collaboration and coordination of the role pharmacyhas in disaster management
Set procedures for emergency cart fills Resources are provided for efficient communication and
protection
Provide staff education
Conduct drills to optimize functioning of the team
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How to Prepare: Be Educated and
Trained
Become familiar with agents of concern, theirtreatment, prophylaxis and epidemiology
Take training classes in emergency preparedness
Learn first aid and become certified incardiopulmonary resuscitation (CPR) andadvanced cardiac life support (ACLS)
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How to Prepare: Get Involved
Develop the following Antibiotic selection guidelines
Dosing charts for pediatric patients
Counseling information
Immunization guidelines (especially for high risk patients) Post exposure prophylaxis recommendations both primary and secondary
exposure
Assist in writing pharmaceutical distribution plans
Take part in development of guidelines or treatment algorithms
in management of patients exposed to bioterrorism Work with wholesalers to develop plans to obtain emergency
pharmaceuticals
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How to Prepare: Get Involved
Teach other pharmacists, nurses, and medicalprofessionals
Become certified to administer vaccines
Develop programs for mass prophylaxisfocusing on issues of drug security, triage ofpatients, and counseling
Take part in practice drills or training exercises Federal government can send training, education and
demonstration (TED) packages
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Resources American Society of Health-System Pharmacists
http://www.ashp.org/emergency/
American Pharmaceutical Association (APhA) PharmacistResponse Center http://www.aphanet.org/pharmcare/responsecenter.htm
American Medical Association http://www.ama-assn.org/ama/pub/category/6206.html
Centers for Disease Control (Bioterrorism preparedness andresponse) www.bt.cdc.gov
John Hopkins University for Civilian Biodefense Strategies http://www.upmc-biosecurity.org/
Federal Emergency Management Agency http://www.fema.gov
U.S. Food and Drug Administration http://www.fda.gov/oc/opacom/hottopics/bioterrorism.html
National Disaster Medical System http://www.oep-ndms.dhhs.gov/
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Conclusion
Pharmacists are identified as being an activeparticipant in the preparation and response toevents related to bioterrorism
Pharmacists need to be educated and be activelyinvolved
Utilize the available resources
Be available to volunteer assistance
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References
Terriff CM, Schwartz MD, Lomaestro BM. Bioterrorism: Pivotal Clinical Issues. Pharmacotherapy 2003;23(3):275-90.
American Society of Health-System Pharmacists. ASHP Statement on the Role of Health-System Pharmacists inCounterterrorism. Am J Health-Syst Pharm 2002;59(3):282-3.
American Society of Health-System Pharmacists. Summary of the Executive Session on Emergency Preparednessand the Pharmaceutical Supply Chain Am J Health-Syst Pharm 2002;59(3):247-53.
Teeter DS. Bioterrorism Preparedness: Answers for the Health-System Pharmacist Am J Health-Syst Pharm2002;59(10):928-30.
Gaudette R, Schynitzer , George E, Briggs SM. Lessons Learned from the September 11th World Trade CenterDisaster: Pharmacy Preparedness and Participation in an International Medical and Surgical Response Team.Pharmacotherapy 2002;22(3):271-81.
Schultz CH, Koenig KL, Noji EK. Disaster Preparedness. In: Marx JA, Hockberger RS, Walls RN, editors. RosensEmergency Medicine Concepts and Clinical Practice. London: Mosby; 2002. p. 2631-45.
Department of Homeland Security. National Response Plan; December 2004. Available from:http://www.dhs.gov/dhspublic/theme_home2.jsp
Emergency Preparedness and Response. Centers for Disease Control and Prevention. Available from:http://www.bt.cdc.gov
Cohen V. Organization of a health-system pharmacy team to respond to episodes of terrorism. Am J Health-SystPharm 2003;60:1257-63.
APhA Pharmacist Response Center. Available from: http://www.aphanet.org/pharmcare/responsecenter.htm
http://www.dhs.gov/dhspublic/theme_home2.jsphttp://www.bt.cdc.gov/http://www.bt.cdc.gov/http://www.dhs.gov/dhspublic/theme_home2.jsp