Transcript A Tale of 2 Cities- Disaster Relief from 1,100 Miles Away

A Tale of 2 Cities- Disaster
Relief from 1,100 Miles Away
Christopher Arendt, PharmD
Pharmacotherapy Coordinator
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Disclosure
• Nothing to disclose.
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Objectives
• After attending this lecture the participant
should be able to:
– Describe the system used to provide
maintenance medications to disaster victims.
– Understand the lessons learned in preparing
for Mass dispensing.
– Recognize the importance of the chain of
command during a disaster.
– Describe the ideal supply chain and distribution
system in a disaster
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The Scenario
Katrina
Aug 28th 2005
Rita
Sept 21st, 2005
Katrina Photo: Jeff Schmaltz, MODIS Rapid Response Team, NASA/GSFC
Rita Photo: Jacques Descloitres, MODIS Rapid Response Team,
NASA/GSFC
Health
Recovery Week
16 Months later
Jan 28th -Feb 3rd
2007
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Mayo gets a phone call from the
State of Minnesota
• Thousands of Refugee’s will be sent to
Camp Ripley in Northern Minnesota in the
next 3 to 5 days. Be ready to receive by
September 5th, 2005.
• Need Medical attention. Primary care
needs. Medications. Food. Shelter. Staff.
Mental Health. Social workers. Security.
Operation “Northern Comfort”
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Mayo Responds
• Sent Computers (Guardian Rx),
Printers, Labels, Office Supplies
• Sent Pharmaceuticals
• Arranged Wholesaler (Cardinal)
Delivery on-Site through
Carrier.
• Sent Pharmacy Supplies
• Established contacts and
supply chain network
• Established Pharmacist/Tech
commitment from Mayo and
other MN pharmacies (MPhA)
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Mayo Responds
Operation: “Northern Comfort”
Camp Ripley
9/5/2005
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We were ready…
…and they never came to
Minnesota.
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ACT 2
• The Louisiana Office of Public Health asks
Mayo for assistance Sept 9th, 2005.
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The Mayo Response
• Mayo looks for volunteers in key areas
– Logistics/ Security/ IT
– Nurses/Care Assistants/Clerical Support
– Providers/NP/MD
• Mental Health
• Internal Med/Family Med/Peds
• Infectious Disease
– Pharmacy
• Pharmacist/Technician
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The Mayo Response
• Mayo in conjunction with
University of Minnesota and
College of St. Katherine's
established the “Minnesota
Lifeline” Medical group.
• Team 1 left Monday 9/12/05
morning w/ 9 vans
• Team 2 left -9/14/05 Wednesday
on Commercial Flight out of
MSP with U of M folks.
• 2 Trucks with supplies headed
south 9/12/05
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The Pharmacy Response
Robust Supplies. Repackaged Alphabetically into numbered
totes for ease of retrieval.
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The Pharmacy Response
Alphabetical labeling
and Pharmaceuticals
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The Pharmacy Response
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Formulary
Code Supplies
The Pharmacy Response
Scheduled Drugs and ability to
account for them
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The Pharmacy Response
Personal Packs
Ciprofloxacin 500 mg
tabs BID x 3 days
Disp # 6
If Allergy- Got
Azithromycin
(ZPak)
Loperamide (Imodium) 2
caps now. Then 1 cap
after each loose stool.
Max 16 mg/24 hrs.
Disp # 30.
Alcohol Based Sanitizer
Drug Info Sheet
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The Pharmacy Response
• Computer system and Labeling system
(Guardian Rx). Zebra Thermal Printer,
Laser Printer
• Pharmacy supplies (vials, ovals, beakers)
• Misc Supplies (Calculator, pens, marker,
tablet cutters, grinders, mortar and pestle,
scissors, forms, drug info resources, drug
info, stapler, Pharmacy tape dispense,
note pads, baggies etc….)
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The Pharmacy Response
• Vaccine
– Pneumococcal
– Hepatitis A, B
– Influenza
– Tetanus
– MMR
Used to
supplement Public
Health Supplies of
Vaccine
Let’s Talk Do’s
and Don’ts
• Needle Stick Emergency Kit
– Lamivudine + Zidovudine (Combivir)
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Pharmacy Teams
• Pharmacist + Tech
– 8 Weeks of support, 4 teams ( 2 weeks/team)
• Support of department/Inst
– “Whatever it takes”
• Pharmacy Job: Assembled, managed and
ordered drug supplies day and night
• Helped administer at vaccination sites
• Opened a Disaster-relief Out-Patient
Pharmacy out of an RV
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Where did the supplies
come from?
•Public Health
•Mayo
•Private Donations
•Manufacturers
•Wholesalers
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Protect your
assets!
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What do you do when another disaster
strikes during your relief effort?
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What is your communication
back up plan?
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Lessons Learned
.
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Communication is critical
• Establish ONE phone contact number
– But always have a backup
• Calling Tree and Phone Rosters at your
finger tips
• Know key players throughout your profession
– Boards of Pharmacy
– State Health Officials
– Industry
• Suppliers
• Data/IT/IS
– Have 24 hour contact lists
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Communication is critical
• Establish collaborative agreements right
away
– Therapeutic Substitution
– Rx Writing
• DEA List/RX
Pads Info- Get info pre-deployment
.
• Know State Requirements/Get Medicare & Medicaid Provider
info up-front
– Contact Local Pharmacies for Support
• Set up time to call, facilitate communication w/in
chains. Ie…CVS, Walgreens, Wal-Mart
– Talk with the DEA right away
• Suppliers need permissions up front to ship ALL
meds.
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Communication is critical
• Establish supply chain rules
– Must go through one contact for all donations
and purchases of pharmaceuticals
• Minimize “Dumping” of expired meds
• Allows better inventory accountability
• Reduces time spent (Discovery, follow-up,
disposal)
– Have a disposal plan
– Have a re-distribution plan
• Ie…Charitable Pharmacy
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Team
• Send people in pairs (Buddy System).
• Send people with similar interests and
personalities.
• Send people without young children.
• If it involves drugs, include pharmacy up
front. [Vaccine fiasco]
• Establish sound chains of Team
Command. Give everyone a copy.
• Recruit more help from others.
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Team
• Help monitor each others stress and exhaustion
levels (Buddy system)
• If you set up a meeting time, stick to it.
• Recognize the roles and responsibilities of other
team members. Help each other if you can, or at
least offer to help.
• No job is beneath any team member. No job is
above any team member.
• Starting at 5AM and ending at 2AM..a really bad
idea
• Mix up teams - makes greater satisfaction
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With or without walls it can
become a pharmacy!
MN Comfort
Camp Ripley, MN
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With or without walls it can
become a pharmacy!
Mobile Pharmacy
Lafayette LA
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If you pile it they will come…
Camp Ripley,
MN
Set up Stock rules
• Entry point in ONE
Location
– Wasted time tracking
down items. Some items
turned up weeks later.
• Establish delivery lines
and times
Heyman
Center
Pharmacy,
LA
– Fed Ex
– UPS
– Distributor
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Totes-Push Packs and Go-Kits
• Standardize the pack
• Pack by Therapeutic class, not by drug
name.
• Always use both generic and trade names
to label items in the Therapeutic Class.
• Less is more
• If items require refrigeration, buy more
refrigeration, coolers, make ice, and check
multiple times daily to ensure it’s done. 34
Totes-Push Packs and Go-Kits
• Split the work between multiple people
(day/eve/night)
• Set ground rules in the beginning
– You restock pack or you fill out the stock
request form (let us know what you used).
– Establish “ownership” of the kit with providers
– If you need something new, let me know early
so I can try to get it here by tomorrow.
– Remove redundancy ( 1 item per class)
• Set up a FORMULARY
• Ie..you don’t need 5 different ACE Inhibitors.
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Team Prescriptions
• Personal packs
–
–
–
–
Great idea.
Could go with Bulk Bottles to save time/effort.
Get allergy list pre-departure for Emergency
Was a method of taking attendance
• Bus Med Bag
– Nausea, Headache, Travel Sickness and Back pain Kit.
– Sent legend drugs (don’t get back) after c/o motion sickness
• No Legend drugs with last bus.
– Send with bus “Charge” person. Inform Team of Bag on Bus
• Employee Prescriptions
– No problem, but if it requires refrigeration…No.
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Emergency Supplies
• Code Cart
– Nice to have there, but not used
• Was never unwrapped from Shrink wrapping
– No one performed daily checks
• Sent documentation log with modified procedure
• Need self diagnostic style machines (AED Pro)
– 4 AED’s also sent out with teams
• Should send AED with each team & make sure
they know how to use.
• Need more AED’s
• Contacted MFR…Backfilled our needs.
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Lessons for Incident Command
• One person needs to coordinate the phone
list!
• More Phones and Computers for Group
• Keep the All Inclusive morning meeting
• Keep the Round Table approach to Q/A
– Get a bigger table & room- Many players.
• Give the Command Structure and Contact
list to EVERY Team Member (lanyard
around neck)
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Pharmacy Services
• Think outside the rule laden box.
• In-Patient and Out-Patient Pharmacy collaboration
achieved remarkable results.
• Even the best drawn plans are merely sketches.
• Be open and ready to explore alternative methods
of accomplishing a task.
• Be willing to ask for help.
• Having one person responsible for coordination is a
must.
• Keep the staff aware of what is going on.
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The Ideal Supply Chain
•
•
•
•
•
•
Central point of Distribution/ repackaging
Real time shipping status
Mobile Distribution units
Real Time counts/Use reports
Direct from supplier shipping 24/7
Portable med management system /Drug info
resources
• Language resources
• Financial support
• Teamwork
WEB
PDA
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Can Technology Bridge the
Gap?
…YES! But…
• Need power
• Need Communications
• Need User Understanding (JIT Training)
• When we go to a sticks and stones
mentality, this won’t work.
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Summary
• Be Fluid, Flexible and try to have Fun
• Communication, Communication Communication.
– Solid, scheduled and redundant.
• Know your Chain-of-Command and follow it
• Pharmacy involvement early on makes the logistics
easier
• While the Ideal Supply Chain does not exist, good
support can make a major difference
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Thank you!
Contact Information
Christopher Arendt, PharmD
Pharmacotherapy Coordinator
Mayo Clinic, Saint Marys Hospital
1216 2nd ST SW
Rochester, MN 55902
507-255-0384 (w)
[email protected]
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